A bill to extend the authorization of the Highlands Conservation Act.

S. XXXX/H.R. XXXX: must-pass vehical for lands package including, H.R. 502, S. 596: Permanent Reauthorization of Land and Water Conservation Fund; S. 1460: Murkowski-Cantwell LWCF provision; S. 1514: HELP for Wildlife Act; S. 826: WILD Act provision; H.R. 2863 LAND Act; H.R. 2951/S. 1613 Modernization of PR Fund for Tomorrow's Needs Act; H.R. 4645/S. 501 East Rosebud Wild and Scenic River Act; H.R. 4883, S. 2337: Continental Divide Recreation, Wilderness and Camp Hale Legacy Act; H.R. 4644, S. 941: Yellowstone Gateway Protection Act; H.R. 4257, S. 2078: Advancing Conservation and Education (ACE) Act; H.R. 3543, S. 1417: Sage-Grouse and Mule Deer Habitat Conservation and Restoration Act; H.R. 3400, S. 1633: Recreation Not Red-Tape Act; H.R. 1308, S. 513: Frank and Jeanne Moore Wild Steelhead Special Management Area Designation Act; H.R. 1285, S. 483: Wild Olympics Wilderness and Wild and Scenic Rivers Act; H.R. 1281, S. 1627: Reauthorize the Highlands Conservation Act; H.R. 1056: Molalla River Wild and Scenic Rivers Act; H.R. 857, S. 32: California Off-Road Recreation and Conservation Act; H.R. 825, S. 282: Public Land Renewable Energy Development Act; H.R. 2768, S. 1271: Fowler and Boskoff Peaks Designation Act; S. 2721: San Juan Mountains Wilderness Act; S. 507: Blackfoot Clearwater Stewardship Act; H.R. 5600, S. 432: Cerros del Norte Conservation Act; S. 441: Organ Mountains-Desert Peaks Conservation Act; H.R. 1889, S. 820: ANWR Wilderness Act; H.R. 788, S. 593: Target Practice and Marksmanship Training Support Act; H.R. 4465, S. 2166: Endangered Fish Recovery Programs Extension Act; H.R. 3186, S. 1522: Every Kid Outdoors Act; S. 1833: Hardrock Mining and Reclamation Act; S. 2354: Antiquities Act; H.R. 2044, S. 948: America's Red Rock Wilderness Act; S. 733: Sportsmen's Act provisions; Good Samaritan; Castle Mountains bill; H.R. 4647: Recovering America's Wildlife Act; S. 566: Methow Headwaters Protection Act H.R. 5515: National Defense Authorization Act of FY2019 H.R. 502, S. 596: permanent reauthorization and dedicated funding for the Land and Water Conservation Fund H.R. 6147, S. 3073: FY19 Interior-EPA appropriations bill Draft Environmental Impact Statement (DEIS) for the state's sage grouse resource management plans Oppose congressional efforts to streamline the National Environmental Policy Act

Client expense: $43,223 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Bureau of Land Management (BLM), Council on Environmental Quality (CEQ), HOUSE OF REPRESENTATIVES, Interior, Dept of (DOI), SENATE, U.S. Fish & Wildlife Service (USFWS), U.S. Forest Service, White House Office

S. XXXX/H.R. XXXX: must-pass vehical for lands package including, H.R. 502, S. 896: Permanent Reauthorization of Land and Water Conservation Fund; H.R. 6759, S. 569: Land and Water Conservation Fund Authorization and Funding Act; S. 1460: Murkowski-Cantwell LWCF provision; S. 1514: HELP for Wildlife Act; S. 826: WILD Act provision; H.R. 2863 LAND Act; H.R. 2951/S. 1613 Modernization of PR Fund for Tomorrow's Needs Act; H.R. 4645/S. 501 East Rosebud Wild and Scenic River Act; H.R. 4883, S. 2337: Continental Divide Recreation, Wilderness and Camp Hale Legacy Act; H.R. 4644, S. 941: Yellowstone Gateway Protection Act; H.R. 4257, S. 2078: Advancing Conservation and Education (ACE) Act; H.R. 3543, S. 1417: Sage-Grouse and Mule Deer Habitat Conservation and Restoration Act; H.R. 3400, S. 1633: Recreation Not Red-Tape Act; H.R. 1308, S. 513: Frank and Jeanne Moore Wild Steelhead Special Management Area Designation Act; H.R. 1285, S. 483: Wild Olympics Wilderness and Wild and Scenic Rivers Act; H.R. 1281, S. 1627: Reauthorize the Highlands Conservation Act; H.R. 1056: Molalla River Wild and Scenic Rivers Act; H.R. 857, S. 32: California Off-Road Recreation and Conservation Act; H.R. 825, S. 282: Public Land Renewable Energy Development Act; H.R. 2768, S. 1271: Fowler and Boskoff Peaks Designation Act; S. 2721: San Juan Mountains Wilderness Act; S. 507: Blackfoot Clearwater Stewardship Act; H.R. 5600, S. 432: Cerros del Norte Conservation Act; S. 441: Organ Mountains-Desert Peaks Conservation Act; H.R. 1889, S. 820: ANWR Wilderness Act; H.R. 788, S. 593: Target Practice and Marksmanship Training Support Act; H.R. 4465, S. 2166: Endangered Fish Recovery Programs Extension Act; H.R. 3186, S. 1522: Every Kid Outdoors Act; S. 1833: Hardrock Mining and Reclamation Act; S. 2354: Antiquities Act; H.R. 2044, S. 948: America's Red Rock Wilderness Act; S. 733: Sportsmen's Act provisions; Good Samaritan; Castle Mountains bill; H.R. 4647: Recovering America's Wildlife Act; S. 566: Methow Headwaters Protection Act H.R. 5515: National Defense Authorization Act of FY2019 H.R. 502, S. 596: permanent reauthorization and dedicated funding for the Land and Water Conservation Fund H.R. 6147, S. 3073: FY19 Interior-EPA appropriations bill Draft Environmental Impact Statement (DEIS) for the state's sage grouse resource management plans Oppose congressional efforts to streamline the National Environmental Policy Act

HR 1106 Small Tracts Conveyance Act HR 1281, S 1627 Highlands Conservation Act Extension HR 1434, S 571 Chattahoochee-Oconee National Forest Land Adjustment Act S 569 Land and Water Conservation Authorization and Funding Act S 896 Land and Water Conservation Fund Authorization HR 1965 LAND Act HR 1157 Monomoy National Wildlife Refuge HR 1350, S 502 Voyageurs National Park HR 232 State National Forest Management Act HR 267 Martin Luther King Jr. National Historic Park Act HR 344 Forest Legacy Management Flexibility Act S 32 California Desert Protection and Recreation Act HR 502 Land and Water Conservation Fund Authorization S 117 Alex Diekmann Peak Designation Act HR 763, S 257 Acadia National Park Boundary Clarification Act HR 621 Disposal of Excess Federal Lands Act S 363, HR 1026 North Country National Scenic Trail Route Adjustment Act HR 1099 North American Wetlands Conservation Extension Act HR 2167 Acre In Acre Out Act HR 1424 National Scenic Trails Parity Act S 751, HR 2584 National Park Service Legacy Act HR 2863 Land and National Park Deferred Maintenance Act HR 2862 Wildfire Disaster Funding Act HR 2936 Resilient Federal Forests Act HR 2950 Making Public Lands Public Act S 1460 Energy and National Resources Act S 1514 Hunting Heritage and Environmental Legacy Preservation for Wildlife Act S 1522, HR 3186 Every Kid Outdoors Act HR 3668 SHARE Act HR 3990 National Monument Creation and Protection Act HR 4532 Shash Jaa National Monument and Indian Creek National Monument Act HR 4558 Grand Staircase Escalante Enhancement Act HR 4239 SECURE American Energy Act HR 4266, S 2102 Acadia National Park Boundary Clarification Act S 2185 FLTFA Reauthorization Act S 2099 Federal Land Management Act HR 4489 ACCESS Act HR 5133 FLTFA Reauthorization Act Division of Wildfire Suppression Funding and Forest Management Activities Act (bill not yet introduced) HR 5210, S 2509 National Park Restoration Act HR 5170 FLIP Act HR 4179 LWCF Parity for Territories and DC Act HR 4895 Medgar Evers National Monument Act S 3172 Restore Our Parks Act S 3223 Pittman-Robertson Wildlife Restoration Act amendment HR 6410, S 2354 ANTIQUITIES Act

S. XXXX/H.R. XXXX: must-pass vehical for lands package including, H.R. 502, S. 596: Permanent Reauthorization of Land and Water Conservation Fund; S. 1460: Murkowski-Cantwell LWCF provision; S. 1514: HELP for Wildlife Act; S. 826: WILD Act provision; H.R. 2863 LAND Act; H.R. 2951/S. 1613 Modernization of PR Fund for Tomorrow's Needs Act; H.R. 4645/S. 501 East Rosebud Wild and Scenic River Act; H.R. 4883, S. 2337: Continental Divide Recreation, Wilderness and Camp Hale Legacy Act; H.R. 4644, S. 941: Yellowstone Gateway Protection Act; H.R. 4257, S. 2078: Advancing Conservation and Education (ACE) Act; H.R. 3543, S. 1417: Sage-Grouse and Mule Deer Habitat Conservation and Restoration Act; H.R. 3400, S. 1633: Recreation Not Red-Tape Act; H.R. 1308, S. 513: Frank and Jeanne Moore Wild Steelhead Special Management Area Designation Act; H.R. 1285, S. 483: Wild Olympics Wilderness and Wild and Scenic Rivers Act; H.R. 1281, S. 1627: Reauthorize the Highlands Conservation Act; H.R. 1056: Molalla River Wild and Scenic Rivers Act; H.R. 857, S. 32: California Off-Road Recreation and Conservation Act; H.R. 825, S. 282: Public Land Renewable Energy Development Act; H.R. 2768, S. 1271: Fowler and Boskoff Peaks Designation Act; S. 2721: San Juan Mountains Wilderness Act; S. 507: Blackfoot Clearwater Stewardship Act; H.R. 5600, S. 432: Cerros del Norte Conservation Act; S. 441: Organ Mountains-Desert Peaks Conservation Act; H.R. 1889, S. 820: ANWR Wilderness Act; H.R. 788, S. 593: Target Practice and Marksmanship Training Support Act; H.R. 4465, S. 2166: Endangered Fish Recovery Programs Extension Act; H.R. 3186, S. 1522: Every Kid Outdoors Act; S. 1833: Hardrock Mining and Reclamation Act; S. 2354: Antiquities Act; H.R. 2044, S. 948: America's Red Rock Wilderness Act; S. 733: Sportsmen's Act provisions; Good Samaritan; Castle Mountains bill; H.R. 4647: Recovering America's Wildlife Act; S. 566: Methow Headwaters Protection Act H.R. 5515: National Defense Authorization Act of FY2019 H.R. 502, S. 596: permanent reauthorization and dedicated funding for the Land and Water Conservation Fund H.R. 6147, S. 3073: FY19 Interior-EPA appropriations bill Draft Environmental Impact Statement (DEIS) for the state's sage grouse resource management plans Oppose congressional efforts to streamline the National Environmental Policy Act

HR 1106 Small Tracts Conveyance Act HR 1281, S 1627 Highlands Conservation Act Extension S 569 Land and Water Conservation Authorization and Funding Act S 896 Land and Water Conservation Fund Authorization HR 1965 LAND Act S Con Res 3 FY 17 Budget Resolution HR 344 Forest Legacy Management Flexibility Act HR 502 To permanently reauthorize the Land and Water Conservation Fund S 117 Alex Diekmann Peak Designation Act HR 621 Disposal of Excess Federal Lands Act HR 2863 Land and National Park Deferred Maintenance Act HR 2950 Making Public Lands Public Act S 1460 Energy and National Resources Act S 1514 Hunting Heritage and Environmental Legacy Preservation for Wildlife Act HR 3668 SHARE Act HR 4179 LWCF Parity for Territories and DC Act HR4239 SECURE American Energy Act S2099 Federal Lan Management Act HR 4489 ACCESS Act HR 2167 Acre In Acre Out Act S 751, HR 2584 National Park Service Legacy Act HR 5210, S 2509 National Park Restoration Act HR 5170 FLIP Act

Client expense: $80,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Interior, Dept of (DOI), SENATE

HR 1106 Small Tracts Conveyance Act HR 1281, S 1627 Highlands Conservation Act Extension HR 1434, S 571 Chattahoochee-Oconee National Forest Land Adjustment Act S 569 Land and Water Conservation Authorization and Funding Act S 896 Land and Water Conservation Fund Authorization HR 1965 LAND Act HR 1157 Monomoy National Wildlife Refuge HR 1350, S 502 Voyageurs National Park H Res 5 House Rules Package HR 232 State National Forest Management Act S Con Res 3 FY 17 Budget Resolution HR 267 Martin Luther King Jr. National Historic Park Act HR 344 Forest Legacy Management Flexibility Act S 32 California Desert Protection and Recreation Act HR 502 Land and Water Conservation Fund Authorization S 117 Alex Diekmann Peak Designation Act HR 763, S 257 Acadia National Park Boundary Clarification Act HR 621 Disposal of Excess Federal Lands Act S 363, HR 1026 North Country National Scenic Trail Route Adjustment Act H Con Res 27 America's Federal Public Lands HR 1099 North American Wetlands Conservation Extension Act HR 2167 Acre In Acre Out Act HR 1424 National Scenic Trails Parity Act S 751, HR 2584 National Park Service Legacy Act HR 2863 Land and National Park Deferred Maintenance Act HR 2862 Wildfire Disaster Funding Act HR 2936 Resilient Federal Forests Act HR 2950 Making Public Lands Public Act S 1460 Energy and National Resources Act S 1514 Hunting Heritage and Environmental Legacy Preservation for Wildlife Act S 1522, HR 3186 Every Kid Outdoors Act HR 3668 SHARE Act HR 3990 National Monument Creation and Protection Act HR 4532 Shash Jaa National Monument and Indian Creek National Monument Act HR 4558 Grand Staircase Escalante Enhancement Act HR 4239 SECURE American Energy Act HR 4266, S 2102 Acadia National Park Boundary Clarification Act S 2185 FLTFA Reauthorization Act S 2099 Federal Land Management Act HR 4489 ACCESS Act HR 5133 FLTFA Reauthorization Act Division of Wildfire Suppression Funding and Forest Management Activities Act (bill not yet introduced) HR 5210, S 2509 National Park Restoration Act HR 5170 FLIP Act HR 4179 LWCF Parity for Territories and DC Act HR 4895 Medgar Evers National Monument Act

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program; voiced strong opposition to the American Health Care Act/Better Care Reconciliation Act/Graham-Cassidy proposal because these bills would cap the federal contribution to Medicaid or block grant the program, end support for Medicaid expansion, allow state waivers to eliminate essential evidence-based benefits, cut funding for opioid use treatment, restrict access to womens health services, and replace the Affordable Care Acts income-based premium and cost-saving subsidies with regressive age-based ones that will raise premiums and deductibles for most Americans, especially, for older, poorer and sicker patients. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments in 2019; proposing specific alternatives to CMS Advancing Care Information program that is to replace the current Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Clinical Practice Improvement categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians; that CMS use its authority to adjust resource use down from 10 percent in the first performance period by setting resource use at zero and increasing the quality performance category by 10 percent to make up for the difference; that CMS ensures the utmost transparency in how the Agency attributes cost, based on the use of the patient relationship categories and codes, along with the codes for care episodes and patient conditions; that CMS allow all Accountable Care Organizations (ACOs) to be eligible to participate in Track 1+ and to not restrict participation based on ACO size or composition (ex. only physician-led ACOs or small ACOs); that CMS allow current ACOs to move into Track 1+ at the start of any performance year and not be required to wait until the beginning of their next three-year agreement period; that Track 1+ utilize the same benchmarking methodology used for the other MSSP tracks; that CMS implement a minimum threshold of 5,000 beneficiaries for Track 1+, which is consistent with the other MSSP tracks but is lower than the 10,000 (or 7,500 for rural ACOs) beneficiary threshold used in the Next Generation ACO model. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Urged lawmakers to combine DGME and IME into a single, more functional payment program, and broaden the GME financing structure to include all payers; Allocate GME funds transparently and specifically to activities that further the educational mission of teaching and training residents and fellows with input from practicing clinicians and in collaboration with their professional organizations. FY2018 Appropriations: Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps. Also, advocated for the reauthorization of critical workforce programs that expired on Sept. 30, 2017 including, Community Health Centers, the Teaching Health Center Graduate Medical Education program, the National Health Services Corps, and expired on Dec. 8th, the Title VII Health Professions programs; Advocated for raising the budget caps equally on defense and non-defense discretionary spending; Restore $40 million in unobligated funds for the National Quality Forum plus $7.5 million in funding for the next two fiscal years. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their cost-sharing reduction subsidies (CSRs) and that those CSRs should be continued indefinitely as part of a larger bipartisan effort to stabilize the individual insurance market. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Reducing Administrative Burdens on Physicians: Urged Congress to reduce administrative tasks that negatively impact physicians and patients, including: 1) Encourage the administration to convene a multi-agency task force to identify tasks that could be streamlined or eliminated, based on a new comprehensive framework to assess the intent and impact of administrative tasks on care as proposed in ACPs policy paper, Putting Patients First by Reducing Administrative Tasks in Health Care. Establish a process to require that CMS and other relevant federal agencies reexamine and replace the existing E/M documentation guidelines with input from practicing clinicians and their professional organizations, 3) Call on federal advisory bodies, such as the Medicare Payment Advisory Commission (MedPAC), to research the effect of administrative tasks on patient and family care experience and outcomes, 4) Facilitate congressional hearings among government, clinician stakeholders, EHR vendors and suppliers to foster collaboration between parties to recognize their role and responsibility in reducing health IT administrative burdens. Opioid Abuse: ACP supports efforts in trying to improve access to care and treatment for those suffering from mental health and substance abuse disorders. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP is supportive of expanding access to naloxone within the community. ACP also supports the policy proposal known as partial-fill. This would allow a patient to elect to receive a portion of a prescription, and return for either a portion of, or the remainder of the prescription, if the pain persists, up to a 30-day maximum. Urged lawmakers to include language in the final House opioids legislative package to ensure healthcare providers who are engaged in population health initiatives have access to the medical records they need, including information on substance use disorders, to effectively and safely treat their patients; Urged lawmakers to reach agreement on a final conference report to the Comprehensive Addiction and Recovery Act (CARA) that would include: Development of a federal interagency task force to review, modify, and update, as appropriate, best practices for pain management and prescribing pain medication; Grants to states to expand awareness and education of physicians, patients, health care providers regarding the risks associated with the misuse of opioids; A comprehensive Prescription Drug Monitoring Program (PDMP) to track the dispensing of controlled substances; Increased availability of opioid overdose reversal drugs; Alternatives to incarceration to individuals who misuse opioid drugs and other substances to manage their pain. The College was also encourage by Administrations Opioid Commission report, released in November, that emphasizes the need to expand access to substance use disorder treatment, for which there is a massive demand in many parts of the country. Chronic Care Management: Urged lawmakers to eliminate the beneficiary co-pay for chronic care management (CCM) services, require reimbursement and coverage of additional codes for more complex CCM services, direct HHS to authorize payment for CCM codes to allow physicians to spend up to 40 minutes with a patient and an additional code that would allow for 60 minutes of treatment for a patient with multiple chronic illnesses; Advocated for passage of The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, S. 870, which would expand the use of tele-health for individuals with stroke, provide flexibility for Medicare beneficiaries to be part of an Accountable Care Organization, extend the Independence at Home model of care. Childrens Health: Advocated for a 5-year extension of the Childrens Health Insurance Program (CHIP), which expired on Sept. 30, 2017, on the basis of it serving as the key health insurance safety net program for children of low-income families. Insurance Market Stabilization: Advocated with Congress on the need to stabilize the health insurance market, including the need to fund cost-sharing reduction (CSRs) payments for the long-term; Urged enactment of legislation, built around robust federal funding for reinsurance that is adequate to ensure stability, encourage competition and lower costs for consumers while maintaining the core consumer protections in current federal statute. Reinsurance provisions of this legislation should be structured in a manner to bring relief to consumers in every state. To assure its sustainability, any legislative solution must be bipartisan. Immigration: Voiced support to Congress on the need to pass the Development, Relief, and Education for Alien Minors (DREAM) Act of 2017, H.R. 3440. This legislation would establish a three-step pathway to U.S. citizenship through college, work, or the armed services for individuals who were born in another country and brought illegally to the U.S. at a young age (DREAMers). Clinical Labs: Commented to the Centers for Medicare and Medicaid Services (CMS) on issues pertaining to the Protecting Access to Medicare Act of 2014 (PAMA), specifically citing concerns about the potential impacts of PAMA on patient access to critical rapid clinical testing services offered to patients while they are receiving medical care in their physicians office; expressed further concerns about impending cuts on Jan. 1, 2018 for physician office-based testing services. Medicare Physician Fee Schedule: Commented to CMS on the CY2018 proposed and final rules on the Physician Fee Schedule, including: any revisions made to the E/M documentation guidelines should not result in a revaluation of the entire E/M code set; all relevant stakeholders, including medical specialty organizations, should work with both the Current Procedural Terminology (CPT) Editorial Panel and CMS to create frameworks outlining general principles of care that are beneficial and appropriate for medical specialties in describing the varying approaches to patient care for the current levels of E/M codes; CMS should simplify the documentation requirements necessary to bill CCM services in order to ease the burden of documenting each separate minute of care management over the course of the month; CMS should modify the existing PAMA regulations through issuance of an interim final rule that provides for CMS to conduct targeted market segment surveys (reference laboratories, physician office-base laboratories, independent laboratories, and hospital outreach laboratories) to validate and adjust the final amount calculated based on the data collection to ensure Congressional intent-payment rates that accurately reflect private market payments across all market segments-is achieved; CMS should provide relief from penalties associated with the Medicare EHR Incentive Program (Meaningful Use) for the 2016 performance period for ECs who tried but were unsuccessful at reporting MU. Medicare Access and CHIP Reauthorization Act (MACRA): Called on CMS to: work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM) pathways, including the development and implementation of the performance measures to be used within these programs; to reduce administrative tasks and burdens on physicians; collaborate with specialty societies, frontline clinicians, patients, and electronic health record (EHR) vendors in the development, testing, and implementation of measures with a focus on integrating the measurement of and reporting on performance with quality improvement and care delivery and decreasing clinician burden. Urged Congress to: continue the existing flexibility in the MACRA statute that CMS is currently using for an additional three years so that the agency may move forward as the necessary program elements are put in place; clarify that Medicare Part B drugs and other items and services outside the physician fee schedule are not included in the application of MIPS payment adjustments and determination of MIPS eligibility; rationalize what is considered a small practice; and explicitly authorize the Physician-focused Payment Model Technical Advisory Committee (PTAC) to provide technical assistance to developers of Advanced Payment Models. State Medicaid Waivers: The College commented to CMS on the Arizona Health Care Cost Containment System (AHCCCS) 1115 Waiver amendment request opposing the request for a 5-year maximum lifetime limit on coverage for certain enrollees. Placing an arbitrary limit on enrollment could disrupt continuity of care and undermine the patient-physician relationship. Patients with chronic conditions may need ongoing care management from their physician and health care team. Abruptly ending a patients medical assistance after 5 years could sever a patients link to their care team and threaten progress. The College also commented to CMS on the KanCare 2.0 State Extension Application opposing the 36-month limit on KanCare 2.0 coverage. This proposal would greatly harm patients with complex chronic care needs, including patients with diabetes, obesity, cardiovascular disease, and asthma, who require ongoing care management. The College also commented to CMS on the New Mexico Centennial Care 2017 Extension Application expressing concerns that the states proposal to implement premiums and cost sharing for the Other Adult Group expansion population with household income that exceeds 100% FPL will undermine access to care. The proposal would impose monthly premiums of $10 in 2019 and provide the state the option of raising the premium to $20 a month in subsequent years. The College believes that Medicaid premiums and cost-sharing should be structured in a way that does not discourage enrollment or cause enrollees to disenroll or delay or forgo care due to cost, especially those with chronic disease. Firearms: The College urged Congress to: Reject any consideration of the Concealed Carry Reciprocity Act (H.R. 38) as passed by the House in December, 2017; Pass S. 2095, the Assault Weapons Ban of 2017, which would place bans on the sale of high-velocity, rapid-fire assault rifles (rifles specifically designed to inflict lethal harm to as many victims as possible, in as little time as possible), large capacity ammunition magazines and bump stocks; Pass S. 2135, the Fix NICS Act, which would strengthen the criminal background check system to help ensure that criminals and domestic abusers are prevented from obtaining firearms; Enact strong penalties for persons who unlawfully purchase firearms for other persons who are in a prohibited category-known as straw purchasers; Repeal the Dickey amendment, which limits the ability of the Centers for Disease Control and Prevention, the National Institutes of Health, and the National Institute of Justice, to study the effect of violence and unintentional firearms-related injury on public health and safety, and to eliminate any language in appropriations bills for these agencies that would preclude them from conducting such studies.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program; voiced strong opposition to the American Health Care Act/Better Care Reconciliation Act/Graham-Cassidy proposal because these bills would cap the federal contribution to Medicaid or block grant the program, end support for Medicaid expansion, allow state waivers to eliminate essential evidence-based benefits, cut funding for opioid use treatment, restrict access to womens health services, and replace the Affordable Care Acts income-based premium and cost-saving subsidies with regressive age-based ones that will raise premiums and deductibles for most Americans, especially, for older, poorer and sicker patients. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments in 2019; proposing specific alternatives to CMS Advancing Care Information program that is to replace the current Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Clinical Practice Improvement categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians; that CMS use its authority to adjust resource use down from 10 percent in the first performance period by setting resource use at zero and increasing the quality performance category by 10 percent to make up for the difference; that CMS ensures the utmost transparency in how the Agency attributes cost, based on the use of the patient relationship categories and codes, along with the codes for care episodes and patient conditions; that CMS allow all Accountable Care Organizations (ACOs) to be eligible to participate in Track 1+ and to not restrict participation based on ACO size or composition (ex. only physician-led ACOs or small ACOs); that CMS allow current ACOs to move into Track 1+ at the start of any performance year and not be required to wait until the beginning of their next three-year agreement period; that Track 1+ utilize the same benchmarking methodology used for the other MSSP tracks; that CMS implement a minimum threshold of 5,000 beneficiaries for Track 1+, which is consistent with the other MSSP tracks but is lower than the 10,000 (or 7,500 for rural ACOs) beneficiary threshold used in the Next Generation ACO model. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Urged lawmakers to combine DGME and IME into a single, more functional payment program, and broaden the GME financing structure to include all payers; Allocate GME funds transparently and specifically to activities that further the educational mission of teaching and training residents and fellows with input from practicing clinicians and in collaboration with their professional organizations FY2018 Appropriations: Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps. Also, advocated for the reauthorization of critical workforce programs that expired on Sept. 30, 2017 including, Community Health Centers, the Teaching Health Center Graduate Medical Education program, the National Health Services Corps, and expired on Dec. 8th, the Title VII Health Professions programs; Advocated for raising the budget caps equally on defense and non-defense discretionary spending; Restore $40 million in unobligated funds for the National Quality Forum plus $7.5 million in funding for the next two fiscal years. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their cost-sharing reduction subsidies (CSRs) and that those CSRs should be continued indefinitely as part of a larger bipartisan effort to stabilize the individual insurance market. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Reducing Administrative Burdens on Physicians: Urged Congress to reduce administrative tasks that negatively impact physicians and patients, including: 1) Encourage the administration to convene a multi-agency task force to identify tasks that could be streamlined or eliminated, based on a new comprehensive framework to assess the intent and impact of administrative tasks on care as proposed in ACPs policy paper, Putting Patients First by Reducing Administrative Tasks in Health Care. Establish a process to require that CMS and other relevant federal agencies reexamine and replace the existing E/M documentation guidelines with input from practicing clinicians and their professional organizations, 3) Call on federal advisory bodies, such as the Medicare Payment Advisory Commission (MedPAC), to research the effect of administrative tasks on patient and family care experience and outcomes, 4) Facilitate congressional hearings among government, clinician stakeholders, EHR vendors and suppliers to foster collaboration between parties to recognize their role and responsibility in reducing health IT administrative burdens. Opioid Abuse: ACP supports efforts in trying to improve access to care and treatment for those suffering from mental health and substance abuse disorders. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP is supportive of expanding access to naloxone within the community. ACP also supports the policy proposal known as partial-fill. This would allow a patient to elect to receive a portion of a prescription, and return for either a portion of, or the remainder of the prescription, if the pain persists, up to a 30-day maximum. Urged lawmakers to include language in the final House opioids legislative package to ensure healthcare providers who are engaged in population health initiatives have access to the medical records they need, including information on substance use disorders, to effectively and safely treat their patients; Urged lawmakers to reach agreement on a final conference report to the Comprehensive Addiction and Recovery Act (CARA) that would include: Development of a federal interagency task force to review, modify, and update, as appropriate, best practices for pain management and prescribing pain medication; Grants to states to expand awareness and education of physicians, patients, health care providers regarding the risks associated with the misuse of opioids; A comprehensive Prescription Drug Monitoring Program (PDMP) to track the dispensing of controlled substances; Increased availability of opioid overdose reversal drugs; Alternatives to incarceration to individuals who misuse opioid drugs and other substances to manage their pain. The College was also encourage by Administrations Opioid Commission report, released in November, that emphasizes the need to expand access to substance use disorder treatment, for which there is a massive demand in many parts of the country. Chronic Care Management: Urged lawmakers to eliminate the beneficiary co-pay for chronic care management (CCM) services, require reimbursement and coverage of additional codes for more complex CCM services, direct HHS to authorize payment for CCM codes to allow physicians to spend up to 40 minutes with a patient and an additional code that would allow for 60 minutes of treatment for a patient with multiple chronic illnesses; Advocated for passage of The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, S. 870, which would expand the use of tele-health for individuals with stroke, provide flexibility for Medicare beneficiaries to be part of an Accountable Care Organization, extend the Independence at Home model of care. Childrens Health: Advocated for a 5-year extension of the Childrens Health Insurance Program (CHIP), which expired on Sept. 30, 2017, on the basis of it serving as the key health insurance safety net program for children of low-income families. Insurance Market Stabilization: Advocated with Congress on the need to stabilize the health insurance market, including the need to fund cost-sharing reduction (CSRs) payments for the long-term; Urged enactment of legislation, built around robust federal funding for reinsurance that is adequate to ensure stability, encourage competition and lower costs for consumers while maintaining the core consumer protections in current federal statute. Reinsurance provisions of this legislation should be structured in a manner to bring relief to consumers in every state. To assure its sustainability, any legislative solution must be bipartisan. Immigration: Voiced support to Congress on the need to pass the Development, Relief, and Education for Alien Minors (DREAM) Act of 2017, H.R. 3440. This legislation would establish a three-step pathway to U.S. citizenship through college, work, or the armed services for individuals who were born in another country and brought illegally to the U.S. at a young age (DREAMers). Clinical Labs: Commented to the Centers for Medicare and Medicaid Services (CMS) on issues pertaining to the Protecting Access to Medicare Act of 2014 (PAMA), specifically citing concerns about the potential impacts of PAMA on patient access to critical rapid clinical testing services offered to patients while they are receiving medical care in their physicians office; expressed further concerns about impending cuts on Jan. 1, 2018 for physician office-based testing services. Medicare Physician Fee Schedule: Commented to CMS on the CY2018 proposed and final rules on the Physician Fee Schedule, including: any revisions made to the E/M documentation guidelines should not result in a revaluation of the entire E/M code set; all relevant stakeholders, including medical specialty organizations, should work with both the Current Procedural Terminology (CPT) Editorial Panel and CMS to create frameworks outlining general principles of care that are beneficial and appropriate for medical specialties in describing the varying approaches to patient care for the current levels of E/M codes; CMS should simplify the documentation requirements necessary to bill CCM services in order to ease the burden of documenting each separate minute of care management over the course of the month; CMS should modify the existing PAMA regulations through issuance of an interim final rule that provides for CMS to conduct targeted market segment surveys (reference laboratories, physician office-base laboratories, independent laboratories, and hospital outreach laboratories) to validate and adjust the final amount calculated based on the data collection to ensure Congressional intent-payment rates that accurately reflect private market payments across all market segments-is achieved; CMS should provide relief from penalties associated with the Medicare EHR Incentive Program (Meaningful Use) for the 2016 performance period for ECs who tried but were unsuccessful at reporting MU. Medicare Access and CHIP Reauthorization Act (MACRA): Called on CMS to: work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM) pathways, including the development and implementation of the performance measures to be used within these programs; to reduce administrative tasks and burdens on physicians; collaborate with specialty societies, frontline clinicians, patients, and electronic health record (EHR) vendors in the development, testing, and implementation of measures with a focus on integrating the measurement of and reporting on performance with quality improvement and care delivery and decreasing clinician burden. Urged Congress to: continue the existing flexibility in the MACRA statute that CMS is currently using for an additional three years so that the agency may move forward as the necessary program elements are put in place; clarify that Medicare Part B drugs and other items and services outside the physician fee schedule are not included in the application of MIPS payment adjustments and determination of MIPS eligibility; rationalize what is considered a small practice; and explicitly authorize the Physician-focused Payment Model Technical Advisory Committee (PTAC) to provide technical assistance to developers of Advanced Payment Models. State Medicaid Waivers: The College commented to CMS on the Arizona Health Care Cost Containment System (AHCCCS) 1115 Waiver amendment request opposing the request for a 5-year maximum lifetime limit on coverage for certain enrollees. Placing an arbitrary limit on enrollment could disrupt continuity of care and undermine the patient-physician relationship. Patients with chronic conditions may need ongoing care management from their physician and health care team. Abruptly ending a patients medical assistance after 5 years could sever a patients link to their care team and threaten progress. The College also commented to CMS on the KanCare 2.0 State Extension Application opposing the 36-month limit on KanCare 2.0 coverage. This proposal would greatly harm patients with complex chronic care needs, including patients with diabetes, obesity, cardiovascular disease, and asthma, who require ongoing care management. The College also commented to CMS on the New Mexico Centennial Care 2017 Extension Application expressing concerns that the states proposal to implement premiums and cost sharing for the Other Adult Group expansion population with household income that exceeds 100% FPL will undermine access to care. The proposal would impose monthly premiums of $10 in 2019 and provide the state the option of raising the premium to $20 a month in subsequent years. The College believes that Medicaid premiums and cost-sharing should be structured in a way that does not discourage enrollment or cause enrollees to disenroll or delay or forgo care due to cost, especially those with chronic disease. Firearms: The College urged Congress to: Reject any consideration of the Concealed Carry Reciprocity Act (H.R. 38) as passed by the House in December, 2017; Pass S. 2095, the Assault Weapons Ban of 2017, which would place bans on the sale of high-velocity, rapid-fire assault rifles (rifles specifically designed to inflict lethal harm to as many victims as possible, in as little time as possible), large capacity ammunition magazines and bump stocks; Pass S. 2135, the Fix NICS Act, which would strengthen the criminal background check system to help ensure that criminals and domestic abusers are prevented from obtaining firearms; Enact strong penalties for persons who unlawfully purchase firearms for other persons who are in a prohibited category-known as straw purchasers; Repeal the Dickey amendment, which limits the ability of the Centers for Disease Control and Prevention, the National Institutes of Health, and the National Institute of Justice, to study the effect of violence and unintentional firearms-related injury on public health and safety, and to eliminate any language in appropriations bills for these agencies that would preclude them from conducting such studies.

HR 1106 Small Tracts Conveyance Act HR 1281, S 1627 Highlands Conservation Act Extension S 569 Land and Water Conservation Authorization and Funding Act S 896 Land and Water Conservation Fund Authorization HR 1965 LAND Act S Con Res 3 FY 17 Budget Resolution HR 344 Forest Legacy Management Flexibility Act HR 502 To permanently reauthorize the Land and Water Conservation Fund S 117 Alex Diekmann Peak Designation Act HR 621 Disposal of Excess Federal Lands Act HR 2863 Land and National Park Deferred Maintenance Act HR 2950 Making Public Lands Public Act S 1460 Energy and National Resources Act S 1514 Hunting Heritage and Environmental Legacy Preservation for Wildlife Act HR 3668 SHARE Act HR 4179 LWCF Parity for Territories and DC Act HR4239 SECURE American Energy Act S2099 Federal Lan Management Act HR 4489 ACCESS Act

Client expense: $90,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Interior, Dept of (DOI), SENATE

HR 1106 Small Tracts Conveyance Act HR 1281, S 1627 Highlands Conservation Act Extension HR 1434, S 571 Chattahoochee-Oconee National Forest Land Adjustment Act S 569 Land and Water Conservation Authorization and Funding Act S 896 Land and Water Conservation Fund Authorization HR 1965 LAND Act HR 1157 Monomoy National Wildlife Refuge HR 1350, S 502 Voyageurs National Park H Res 5 House Rules Package HR 232 State National Forest Management Act S Con Res 3 FY 17 Budget Resolution HR 267 Martin Luther King Jr. National Historic Park Act HR 344 Forest Legacy Management Flexibility Act S 32 California Desert Protection and Recreation Act HR 502 Land and Water Conservation Fund Authorization S 117 Alex Diekmann Peak Designation Act HR 763, S 257 Acadia National Park Boundary Clarification Act HR 621 Disposal of Excess Federal Lands Act S 363, HR 1026 North Country National Scenic Trail Route Adjustment Act H Con Res 27 America's Federal Public Lands HR 1099 North American Wetlands Conservation Extension Act HR 2167 Acre In Acre Out Act HR 1424 National Scenic Trails Parity Act S 751, HR 2584 National Park Service Legacy Act HR 2863 Land and National Park Deferred Maintenance Act HR 2862 Wildfire Disaster Funding Act HR 2936 Resilient Federal Forests Act HR 2950 Making Public Lands Public Act S 1460 Energy and National Resources Act S 1514 Hunting Heritage and Environmental Legacy Preservation for Wildlife Act S 1522, HR 3186 Every Kid Outdoors Act HR 3668 SHARE Act HR 3990 National Monument Creation and Protection Act HR 4532 Shash Jaa National Monument and Indian Creek National Monument Act HR 4558 Grand Staircase Escalante Enhancement Act HR 4239 SECURE American Energy Act HR 4266, S 2102 Acadia National Park Boundary Clarification Act S 2185 FLTFA Reauthorization Act S 2099 Federal Land Management Act HR 4489 ACCESS Act

HR 1106 Small Tracts Conveyance Act HR 1281, S 1627 Highlands Conservation Act Extension HR 1434, S 571 Chattahoochee-Oconee National Forest Land Adjustment Act S 569 Land and Water Conservation Authorization and Funding Act S 896 Land and Water Conservation Fund Authorization HR 1965 LAND Act HR 1157 Monomoy National Wildlife Refuge HR 1350, S 502 Voyageurs National Park H Res 5 House Rules Package HR 232 State National Forest Management Act S Con Res 3 FY 17 Budget Resolution HR 267 Martin Luther King Jr. National Historic Park Act HR 344 Forest Legacy Management Flexibility Act S 32 California Desert Protection and Recreation Act HR 502 Land and Water Conservation Fund Authorization S 117 Alex Diekmann Peak Designation Act HR 763, S 257 Acadia National Park Boundary Clarification Act HR 621 Disposal of Excess Federal Lands Act S 363, HR 1026 North Country National Scenic Trail Route Adjustment Act H Con Res 27 America's Federal Public Lands HR 1099 North American Wetlands Conservation Extension Act HR 2167 Acre In Acre Out Act HR 1424 National Scenic Trails Parity Act S 751, HR 2584 National Park Service Legacy Act HR 2863 Land and National Park Deferred Maintenance Act HR 2862 Wildfire Disaster Funding Act HR 2936 Resilient Federal Forests Act HR 2950 Making Public Lands Public Act S 1460 Energy and National Resources Act S 1514 Hunting Heritage and Environmental Legacy Preservation for Wildlife Act S 1522, HR 3186 Every Kid Outdoors Act HR 3668 SHARE Act HR 3990 National Monument Creation and Protection Act HR 4532 Shash Jaa National Monument and Indian Creek National Monument Act HR 4558 Grand Staircase Escalante Enhancement Act HR 4239 SECURE American Energy Act HR 4266, S 2102 Acadia National Park Boundary Clarification Act S 2185 FLTFA Reauthorization Act S 2099 Federal Land Management Act HR 4489 ACCESS Act

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program; voiced strong opposition to the American Health Care Act/Better Care Reconciliation Act/Graham-Cassidy proposal because these bills would cap the federal contribution to Medicaid or block grant the program, end support for Medicaid expansion, allow state waivers to eliminate essential evidence-based benefits, cut funding for opioid use treatment, restrict access to womens health services, and replace the Affordable Care Acts income-based premium and cost-saving subsidies with regressive age-based ones that will raise premiums and deductibles for most Americans, especially, for older, poorer and sicker patients. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments in 2019; proposing specific alternatives to CMS Advancing Care Information program that is to replace the current Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Clinical Practice Improvement categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians; that CMS use its authority to adjust resource use down from 10 percent in the first performance period by setting resource use at zero and increasing the quality performance category by 10 percent to make up for the difference; that CMS ensures the utmost transparency in how the Agency attributes cost, based on the use of the patient relationship categories and codes, along with the codes for care episodes and patient conditions; that CMS allow all Accountable Care Organizations (ACOs) to be eligible to participate in Track 1+ and to not restrict participation based on ACO size or composition (ex. only physician-led ACOs or small ACOs); that CMS allow current ACOs to move into Track 1+ at the start of any performance year and not be required to wait until the beginning of their next three-year agreement period; that Track 1+ utilize the same benchmarking methodology used for the other MSSP tracks; that CMS implement a minimum threshold of 5,000 beneficiaries for Track 1+, which is consistent with the other MSSP tracks but is lower than the 10,000 (or 7,500 for rural ACOs) beneficiary threshold used in the Next Generation ACO model. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. Urged lawmakers to combine DGME and IME into a single, more functional payment program, and broaden the GME financing structure to include all payers; Allocate GME funds transparently and specifically to activities that further the educational mission of teaching and training residents and fellows with input from practicing clinicians and in collaboration with their professional organizations. FY2018 Appropriations: Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps. Also, advocated for the reauthorization of critical workforce programs that expired on Sept. 30, 2017 including, Community Health Centers, the Teaching Health Center Graduate Medical Education program, the National Health Services Corps, and expiring on Dec. 8th, the Title VII Health Professions programs; Advocated for raising the budget caps equally on defense and non-defense discretionary spending. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their cost-sharing reduction subsidies (CSRs) and that those CSRs should be continued indefinitely as part of a larger bipartisan effort to stabilize the individual insurance market. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Reducing Administrative Burdens on Physicians: Urged Congress to reduce administrative tasks that negatively impact physicians and patients, including: 1)Encourage the administration to convene a multi-agency task force to identify tasks that could be streamlined or eliminated, based on a new comprehensive framework to assess the intent and impact of administrative tasks on care as proposed in ACPs policy paper, Putting Patients First by Reducing Administrative Tasks in Health Care, 2) Establish a process to require that CMS and other relevant federal agencies reexamine and replace the existing E/M documentation guidelines with input from practicing clinicians and their professional organizations, 3) Call on federal advisory bodies, such as the Medicare Payment Advisory Commission (MedPAC), to research the effect of administrative tasks on patient and family care experience and outcomes, 4) Facilitate congressional hearings among government, clinician stakeholders, EHR vendors and suppliers to foster collaboration between parties to recognize their role and responsibility in reducing health IT administrative burdens. Opioid Abuse: ACP supports efforts in trying to improve access to care and treatment for those suffering from mental health and substance abuse disorders. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP is supportive of expanding access to naloxone within the community. ACP also supports the policy proposal known as partial-fill. This would allow a patient to elect to receive a portion of a prescription, and return for either a portion of, or the remainder of the prescription, if the pain persists, up to a 30-day maximum. Urged lawmakers to include language in the final House opioids legislative package to ensure healthcare providers who are engaged in population health initiatives have access to the medical records they need, including information on substance use disorders, to effectively and safely treat their patients; Urged lawmakers to reach agreement on a final conference report to the Comprehensive Addiction and Recovery Act (CARA) that would include: Development of a federal interagency task force to review, modify, and update, as appropriate, best practices for pain management and prescribing pain medication; Grants to states to expand awareness and education of physicians, patients, health care providers regarding the risks associated with the misuse of opioids; A comprehensive Prescription Drug Monitoring Program (PDMP) to track the dispensing of controlled substances; Increased availability of opioid overdose reversal drugs; Alternatives to incarceration to individuals who misuse opioid drugs and other substances to manage their pain. The College was also encourage by Administrations Opioid Commission report, released in November, that emphasizes the need to expand access to substance use disorder treatment, for which there is a massive demand in many parts of the country. Chronic Care Management: Urged lawmakers to eliminate the beneficiary co-pay for chronic care management (CCM) services, require reimbursement and coverage of additional codes for more complex CCM services, direct HHS to authorize payment for CCM codes to allow physicians to spend up to 40 minutes with a patient and an additional code that would allow for 60 minutes of treatment for a patient with multiple chronic illnesses; Advocated for passage of The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, S. 870, which would expand the use of tele-health for individuals with stroke, provide flexibility for Medicare beneficiaries to be part of an Accountable Care Organization, extend the Independence at Home model of care. Childrens Health: Advocated for a 5-year extension of the Childrens Health Insurance Program (CHIP), which expired on Sept. 30, 2017, on the basis of it serving as the key health insurance safety net program for children of low-income families. Insurance Market Stabilization: Advocated with Congress on the need to stabilize the health insurance market, including the need to fund cost-sharing reduction (CSRs) payments for the long-term. Immigration: Voiced support to Congress on the need to pass the Development, Relief, and Education for Alien Minors (DREAM) Act of 2017, H.R. 3440. This legislation would establish a three-step pathway to U.S. citizenship through college, work, or the armed services for individuals who were born in another country and brought illegally to the U.S. at a young age (DREAMers). Clinical Labs: Commented to the Centers for Medicare and Medicaid Services (CMS) on issues pertaining to the Protecting Access to Medicare Act of 2014 (PAMA), specifically citing concerns about the potential impacts of PAMA on patient access to critical rapid clinical testing services offered to patients while they are receiving medical care in their physicians office; expressed further concerns about impending cuts on Jan. 1, 2018 for physician office-based testing services. Medicare Physician Fee Schedule: Commented to CMS on the CY2018 proposed and final rules on the Physician Fee Schedule, including: any revisions made to the E/M documentation guidelines should not result in a revaluation of the entire E/M code set; all relevant stakeholders, including medical specialty organizations, should work with both the Current Procedural Terminology (CPT) Editorial Panel and CMS to create frameworks outlining general principles of care that are beneficial and appropriate for medical specialties in describing the varying approaches to patient care for the current levels of E/M codes; CMS should simplify the documentation requirements necessary to bill CCM services in order to ease the burden of documenting each separate minute of care management over the course of the month; CMS should modify the existing PAMA regulations through issuance of an interim final rule that provides for CMS to conduct targeted market segment surveys (reference laboratories, physician office-base laboratories, independent laboratories, and hospital outreach laboratories) to validate and adjust the final amount calculated based on the data collection to ensure Congressional intent-payment rates that accurately reflect private market payments across all market segments-is achieved; CMS should provide relief from penalties associated with the Medicare EHR Incentive Program (Meaningful Use) for the 2016 performance period for ECs who tried but were unsuccessful at reporting MU. Medicare Access and CHIP Reauthorization Act (MACRA): Called on CMS to: work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM) pathways, including the development and implementation of the performance measures to be used within these programs; to reduce administrative tasks and burdens on physicians; collaborate with specialty societies, frontline clinicians, patients, and electronic health record (EHR) vendors in the development, testing, and implementation of measures with a focus on integrating the measurement of and reporting on performance with quality improvement and care delivery and decreasing clinician burden. Urged Congress to: continue the existing flexibility in the MACRA statute that CMS is currently using for an additional three years so that the agency may move forward as the necessary program elements are put in place; clarify that Medicare Part B drugs and other items and services outside the physician fee schedule are not included in the application of MIPS payment adjustments and determination of MIPS eligibility; rationalize what is considered a small practice; and explicitly authorize the Physician-focused Payment Model Technical Advisory Committee (PTAC) to provide technical assistance to developers of Advanced Payment Models. CMS Innovation Center: Commented on the Centers for Medicare and Medicaid Services (CMS) Innovation Center New Direction Request for Information (RFI) recommending the following: 1) Continuing flexibility and a phased-in approach to participation that will allow physicians and other clinicians to be successful; 2) Allowing multiple pathways for patient-centered medical homes (PCMHs) to qualify as Advanced APMs, including options that do not require physicians to bear more than nominal financial risk; and 3) Prioritizing the testing of models involving physician specialty/subspecialty categories for which there are no current recognized APM/Advanced APM options. The College encouraged CMMI to continue to accelerate the transition from fee-for-service (FFS) payment systems to bundled and risk-adjusted capitation payments, hybrid FFS + bundled/capitated payments, and other payment systems that incentivize value rather than volume. Centers for Disease Control and Prevention: The College expressed concern that the Centers for Disease Control and Prevention (CDC) budget analysts were informed they are discouraged from using seven words - including vulnerable, entitlement, diversity, transgender, fetus, evidence-based and science-based - as they prepare the Presidents Fiscal Year 2019 budget. As the nations premier public health agency, the CDC cannot carry out its mission of improving the health and safety of all Americans when its staff are urged to avoid using basic phrases that are so intrinsic to public health. Tax Reform: Advocated with Congress in opposition to numerous provisions in the Tax Cuts and Jobs Act that repealed the individual insurance mandate and eliminated tax deductions for high medical expenses and student loan interest. Comprehensive Primary Care Plus (CPC+): Advocated with Congress on the merits of the CPC+ program as an innovative physician payment model; specifically touted that CPC+ is the only medical home model that's specifically identified as an advanced APM in the Quality Payment Program under Medicare Part B for those in practices with 50 or fewer clinicians.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program; voiced strong opposition to the American Health Care Act/Better Care Reconciliation Act/Graham-Cassidy proposal because these bills would cap the federal contribution to Medicaid or block grant the program, end support for Medicaid expansion, allow state waivers to eliminate essential evidence-based benefits, cut funding for opioid use treatment, restrict access to womens health services, and replace the Affordable Care Acts income-based premium and cost-saving subsidies with regressive age-based ones that will raise premiums and deductibles for most Americans, especially, for older, poorer and sicker patients. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments in 2019; proposing specific alternatives to CMS Advancing Care Information program that is to replace the current Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Clinical Practice Improvement categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians; that CMS use its authority to adjust resource use down from 10 percent in the first performance period by setting resource use at zero and increasing the quality performance category by 10 percent to make up for the difference; that CMS ensures the utmost transparency in how the Agency attributes cost, based on the use of the patient relationship categories and codes, along with the codes for care episodes and patient conditions; that CMS allow all Accountable Care Organizations (ACOs) to be eligible to participate in Track 1+ and to not restrict participation based on ACO size or composition (ex. only physician-led ACOs or small ACOs); that CMS allow current ACOs to move into Track 1+ at the start of any performance year and not be required to wait until the beginning of their next three-year agreement period; that Track 1+ utilize the same benchmarking methodology used for the other MSSP tracks; that CMS implement a minimum threshold of 5,000 beneficiaries for Track 1+, which is consistent with the other MSSP tracks but is lower than the 10,000 (or 7,500 for rural ACOs) beneficiary threshold used in the Next Generation ACO model. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. Urged lawmakers to combine DGME and IME into a single, more functional payment program, and broaden the GME financing structure to include all payers; Allocate GME funds transparently and specifically to activities that further the educational mission of teaching and training residents and fellows with input from practicing clinicians and in collaboration with their professional organizations. FY2018 Appropriations: Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps. Also, advocated for the reauthorization of critical workforce programs that expired on Sept. 30, 2017 including, Community Health Centers, the Teaching Health Center Graduate Medical Education program, the National Health Services Corps, and expiring on Dec. 8th, the Title VII Health Professions programs; Advocated for raising the budget caps equally on defense and non-defense discretionary spending. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their cost-sharing reduction subsidies (CSRs) and that those CSRs should be continued indefinitely as part of a larger bipartisan effort to stabilize the individual insurance market. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Reducing Administrative Burdens on Physicians: Urged Congress to reduce administrative tasks that negatively impact physicians and patients, including: 1)Encourage the administration to convene a multi-agency task force to identify tasks that could be streamlined or eliminated, based on a new comprehensive framework to assess the intent and impact of administrative tasks on care as proposed in ACPs policy paper, Putting Patients First by Reducing Administrative Tasks in Health Care, 2) Establish a process to require that CMS and other relevant federal agencies reexamine and replace the existing E/M documentation guidelines with input from practicing clinicians and their professional organizations, 3) Call on federal advisory bodies, such as the Medicare Payment Advisory Commission (MedPAC), to research the effect of administrative tasks on patient and family care experience and outcomes, 4) Facilitate congressional hearings among government, clinician stakeholders, EHR vendors and suppliers to foster collaboration between parties to recognize their role and responsibility in reducing health IT administrative burdens. Opioid Abuse: ACP supports efforts in trying to improve access to care and treatment for those suffering from mental health and substance abuse disorders. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP is supportive of expanding access to naloxone within the community. ACP also supports the policy proposal known as partial-fill. This would allow a patient to elect to receive a portion of a prescription, and return for either a portion of, or the remainder of the prescription, if the pain persists, up to a 30-day maximum. Urged lawmakers to include language in the final House opioids legislative package to ensure healthcare providers who are engaged in population health initiatives have access to the medical records they need, including information on substance use disorders, to effectively and safely treat their patients; Urged lawmakers to reach agreement on a final conference report to the Comprehensive Addiction and Recovery Act (CARA) that would include: Development of a federal interagency task force to review, modify, and update, as appropriate, best practices for pain management and prescribing pain medication; Grants to states to expand awareness and education of physicians, patients, health care providers regarding the risks associated with the misuse of opioids; A comprehensive Prescription Drug Monitoring Program (PDMP) to track the dispensing of controlled substances; Increased availability of opioid overdose reversal drugs; Alternatives to incarceration to individuals who misuse opioid drugs and other substances to manage their pain. The College was also encourage by Administrations Opioid Commission report, released in November, that emphasizes the need to expand access to substance use disorder treatment, for which there is a massive demand in many parts of the country. Chronic Care Management: Urged lawmakers to eliminate the beneficiary co-pay for chronic care management (CCM) services, require reimbursement and coverage of additional codes for more complex CCM services, direct HHS to authorize payment for CCM codes to allow physicians to spend up to 40 minutes with a patient and an additional code that would allow for 60 minutes of treatment for a patient with multiple chronic illnesses; Advocated for passage of The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, S. 870, which would expand the use of tele-health for individuals with stroke, provide flexibility for Medicare beneficiaries to be part of an Accountable Care Organization, extend the Independence at Home model of care. Childrens Health: Advocated for a 5-year extension of the Childrens Health Insurance Program (CHIP), which expired on Sept. 30, 2017, on the basis of it serving as the key health insurance safety net program for children of low-income families. Insurance Market Stabilization: Advocated with Congress on the need to stabilize the health insurance market, including the need to fund cost-sharing reduction (CSRs) payments for the long-term. Immigration: Voiced support to Congress on the need to pass the Development, Relief, and Education for Alien Minors (DREAM) Act of 2017, H.R. 3440. This legislation would establish a three-step pathway to U.S. citizenship through college, work, or the armed services for individuals who were born in another country and brought illegally to the U.S. at a young age (DREAMers). Clinical Labs: Commented to the Centers for Medicare and Medicaid Services (CMS) on issues pertaining to the Protecting Access to Medicare Act of 2014 (PAMA), specifically citing concerns about the potential impacts of PAMA on patient access to critical rapid clinical testing services offered to patients while they are receiving medical care in their physicians office; expressed further concerns about impending cuts on Jan. 1, 2018 for physician office-based testing services. Medicare Physician Fee Schedule: Commented to CMS on the CY2018 proposed and final rules on the Physician Fee Schedule, including: any revisions made to the E/M documentation guidelines should not result in a revaluation of the entire E/M code set; all relevant stakeholders, including medical specialty organizations, should work with both the Current Procedural Terminology (CPT) Editorial Panel and CMS to create frameworks outlining general principles of care that are beneficial and appropriate for medical specialties in describing the varying approaches to patient care for the current levels of E/M codes; CMS should simplify the documentation requirements necessary to bill CCM services in order to ease the burden of documenting each separate minute of care management over the course of the month; CMS should modify the existing PAMA regulations through issuance of an interim final rule that provides for CMS to conduct targeted market segment surveys (reference laboratories, physician office-base laboratories, independent laboratories, and hospital outreach laboratories) to validate and adjust the final amount calculated based on the data collection to ensure Congressional intent-payment rates that accurately reflect private market payments across all market segments-is achieved; CMS should provide relief from penalties associated with the Medicare EHR Incentive Program (Meaningful Use) for the 2016 performance period for ECs who tried but were unsuccessful at reporting MU. Medicare Access and CHIP Reauthorization Act (MACRA): Called on CMS to: work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM) pathways, including the development and implementation of the performance measures to be used within these programs; to reduce administrative tasks and burdens on physicians; collaborate with specialty societies, frontline clinicians, patients, and electronic health record (EHR) vendors in the development, testing, and implementation of measures with a focus on integrating the measurement of and reporting on performance with quality improvement and care delivery and decreasing clinician burden. Urged Congress to: continue the existing flexibility in the MACRA statute that CMS is currently using for an additional three years so that the agency may move forward as the necessary program elements are put in place; clarify that Medicare Part B drugs and other items and services outside the physician fee schedule are not included in the application of MIPS payment adjustments and determination of MIPS eligibility; rationalize what is considered a small practice; and explicitly authorize the Physician-focused Payment Model Technical Advisory Committee (PTAC) to provide technical assistance to developers of Advanced Payment Models. CMS Innovation Center: Commented on the Centers for Medicare and Medicaid Services (CMS) Innovation Center New Direction Request for Information (RFI) recommending the following: 1) Continuing flexibility and a phased-in approach to participation that will allow physicians and other clinicians to be successful; 2) Allowing multiple pathways for patient-centered medical homes (PCMHs) to qualify as Advanced APMs, including options that do not require physicians to bear more than nominal financial risk; and 3) Prioritizing the testing of models involving physician specialty/subspecialty categories for which there are no current recognized APM/Advanced APM options. The College encouraged CMMI to continue to accelerate the transition from fee-for-service (FFS) payment systems to bundled and risk-adjusted capitation payments, hybrid FFS + bundled/capitated payments, and other payment systems that incentivize value rather than volume. Centers for Disease Control and Prevention: The College expressed concern that the Centers for Disease Control and Prevention (CDC) budget analysts were informed they are discouraged from using seven words-including vulnerable, entitlement, diversity, transgender, fetus, evidence-based and science-based - as they prepare the Presidents Fiscal Year 2019 budget. As the nations premier public health agency, the CDC cannot carry out its mission of improving the health and safety of all Americans when its staff are urged to avoid using basic phrases that are so intrinsic to public health. Tax Reform: Advocated with Congress in opposition to numerous provisions in the Tax Cuts and Jobs Act that repealed the individual insurance mandate and eliminated tax deductions for high medical expenses and student loan interest. Comprehensive Primary Care Plus (CPC+): Advocated with Congress on the merits of the CPC+ program as an innovative physician payment model; specifically touted that CPC+ is the only medical home model that's specifically identified as an advanced APM in the Quality Payment Program under Medicare Part B for those in practices with 50 or fewer clinicians.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program; voiced strong opposition to the American Health Care Act/Better Care Reconciliation Act/Graham-Cassidy proposal because these bills would cap the federal contribution to Medicaid or block grant the program, end support for Medicaid expansion, allow state waivers to eliminate essential evidence-based benefits, cut funding for opioid use treatment, restrict access to womens health services, and replace the Affordable Care Acts income-based premium and cost-saving subsidies with regressive age-based ones that will raise premiums and deductibles for most Americans, especially, for older, poorer and sicker patients. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments in 2019; proposing specific alternatives to CMS Advancing Care Information program that is to replace the current Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Clinical Practice Improvement categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians; that CMS use its authority to adjust resource use down from 10 percent in the first performance period by setting resource use at zero and increasing the quality performance category by 10 percent to make up for the difference; that CMS ensures the utmost transparency in how the Agency attributes cost, based on the use of the patient relationship categories and codes, along with the codes for care episodes and patient conditions; that CMS allow all Accountable Care Organizations (ACOs) to be eligible to participate in Track 1+ and to not restrict participation based on ACO size or composition (ex. only physician-led ACOs or small ACOs); that CMS allow current ACOs to move into Track 1+ at the start of any performance year and not be required to wait until the beginning of their next three-year agreement period; that Track 1+ utilize the same benchmarking methodology used for the other MSSP tracks; that CMS implement a minimum threshold of 5,000 beneficiaries for Track 1+, which is consistent with the other MSSP tracks but is lower than the 10,000 (or 7,500 for rural ACOs) beneficiary threshold used in the Next Generation ACO model. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. Urged lawmakers to combine DGME and IME into a single, more functional payment program, and broaden the GME financing structure to include all payers; Allocate GME funds transparently and specifically to activities that further the educational mission of teaching and training residents and fellows with input from practicing clinicians and in collaboration with their professional organizations. FY2018 Appropriations: Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps. Also, advocated for the reauthorization of critical workforce programs that expired on Sept. 30, 2017 including, Community Health Centers, the Teaching Health Center Graduate Medical Education program, the National Health Services Corps, and expiring on Dec. 8th, the Title VII Health Professions programs. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their cost-sharing reduction subsidies (CSRs) and that those CSRs should be continued indefinitely as part of a larger bipartisan effort to stabilize the individual insurance market. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reducing Administrative Burdens on Physicians: Urged Congress to reduce administrative tasks that negatively impact physicians and patients, including: 1)Encourage the administration to convene a multi-agency task force to identify tasks that could be streamlined or eliminated, based on a new comprehensive framework to assess the intent and impact of administrative tasks on care as proposed in ACPs policy paper, Putting Patients First by Reducing Administrative Tasks in Health Care, 2) Establish a process to require that CMS and other relevant federal agencies reexamine and replace the existing E/M documentation guidelines with input from practicing clinicians and their professional organizations, 3) Call on federal advisory bodies, such as the Medicare Payment Advisory Commission (MedPAC), to research the effect of administrative tasks on patient and family care experience and outcomes, 4) Facilitate congressional hearings among government, clinician stakeholders, EHR vendors and suppliers to foster collaboration between parties to recognize their role and responsibility in reducing health IT administrative burdens. Opioid Abuse: ACP supports efforts in trying to improve access to care and treatment for those suffering from mental health and substance abuse disorders. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP is supportive of expanding access to naloxone within the community. ACP also supports the policy proposal known as partial-fill. This would allow a patient to elect to receive a portion of a prescription, and return for either a portion of, or the remainder of the prescription, if the pain persists, up to a 30-day maximum. Urged lawmakers to include language in the final House opioids legislative package to ensure healthcare providers who are engaged in population health initiatives have access to the medical records they need, including information on substance use disorders, to effectively and safely treat their patients; Urged lawmakers to reach agreement on a final conference report to the Comprehensive Addiction and Recovery Act (CARA) that would include: Development of a federal interagency task force to review, modify, and update, as appropriate, best practices for pain management and prescribing pain medication; Grants to states to expand awareness and education of physicians, patients, health care providers regarding the risks associated with the misuse of opioids; A comprehensive Prescription Drug Monitoring Program (PDMP) to track the dispensing of controlled substances; Increased availability of opioid overdose reversal drugs; Alternatives to incarceration to individuals who misuse opioid drugs and other substances to manage their pain. Zika: ACP urged lawmakers to pass legislation that would provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the Zika virus that is commensurate with the public health emergency that the virus represents. Prescription Drugs: ACP advocated support for lawmakers efforts in preventing some brand-name drug-companies from using statutorily required Food and Drug Administration (FDA) risk and safety programs to stifle other companies development of generic and biosimilar versions of brand-name drugs, specifically through introduction of the CREATES Act. Urged lawmakers to increase transparency in drug pricing by requiring pharmaceutical manufacturers to publically disclose production costs including research and development investments for specific high�cost drugs that the Secretary identifies through regulation; Authorize and appropriate $2.74 billion in discretionary spending for the FDA to expedite, through fast-track approval, new drugs that address unmet medical need in the treatment of a serious or life threatening condition, as well as to address the back-log of pending generic drug applications; Grant authority to the Secretary of HHS to negotiate prescription drug prices with manufacturers for prescription drugs covered under Part D of the Medicare program. Expressed support for S. 41, the Medicare Prescription Drug Price Negotiation Act that will empower the Secretary of Health and Human Services to negotiate with pharmaceutical manufacturers the prices (including discounts, rebates, and other price concessions) that may be charged for prescription drugs covered under Medicare Part D in prescription drug plans that participate in this program; Supported provisions in the FDA Reauthorization Act that provide goal dates for all outstanding generic applications; establishment of priority review timelines for generic drugs; and efforts to continue building the biosimilars review program. Medical Liability Reform: Expressed support for H.R. 1215, the Protecting Access to Care Act of 2017, which would set a federal limit on the amount of non-economic damages to $250,000 and would enact a fair share rule that specifies that in any health care lawsuit, each party shall be liable for that partys share of damages only and not for the share of any other person. It would specify that any state law that imposes different standards on non-economic damages or separate limits on a partys share of damages would supersede any new caps imposed by this legislation regardless of whether the amount imposed by the states is greater or less than those imposed by H.R. 1215; Supported legislation that allows physicians who document adherence to certain evidence-based clinical-practice guidelines and, when applicable, appropriate use criteria, a safe harbor from medical malpractice litigation, as proposed by the Saving Lives, Saving Cost Act, H.R. 1565. Chronic Care Management: Urged lawmakers to eliminate the beneficiary co-pay for chronic care management (CCM) services, require reimbursement and coverage of additional codes for more complex CCM services, direct HHS to authorize payment for CCM codes to allow physicians to spend up to 40 minutes with a patient and an additional code that would allow for 60 minutes of treatment for a patient with multiple chronic illnesses; Advocated for passage of The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, S. 870, which would expand the use of tele-health for individuals with stroke, provide flexibility for Medicare beneficiaries to be part of an Accountable Care Organization, extend the Independence at Home model of care. Telemedicine: Urged lawmakers to broadly lift geographic restrictions on telemedicine, facilitate the use of such telehealth services in stroke treatment, and incorporate the use of these services into ACOs, cosponsor bipartisan legislation, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) For Health Act (the CONNECT For Health Act), H.R. 4442/S. 2484, which would expand the use of telemedicine and remote patient monitoring (RPM) services by physicians to improve care of patients enrolled in Medicare. Mental Health: Urged lawmakers to establish grants, including Innovation and Demonstration grants, to State and local governments, educational institutions, and nonprofit organizations for integrating or coordinating physical health, mental health and substance abuse services; Provide a defined portion of grant funding to the effective integration of services to address mental illness and substance abuse within the primary care setting and to expand a workforce trained to integrate behavioral health within the primary care setting. Childrens Health: Advocated for a 5-year extension of the Childrens Health Insurance Program (CHIP), which expired on Sept. 30, 2017, on the basis of it serving as the key health insurance safety net program for children of low-income families. Insurance Market Stabilization: Commented on the Centers for Medicare and Medicaid Services (CMS) Proposed Rule: Patient Protection and Affordable Care Act; Market Stabilization. Specifically, the Agency should not allow issuers to deny coverage enrollees with bad debt; instead, the issuer should be required to enroll the individual and allow the enrollee to pay the outstanding debt over a period of time; recommended that the open enrollment period for plan year 2018 begin on November 1, 2017 and end on January 31, 2018; States operating a state-based, state-based/federal platform, and partnership marketplaces should be permitted to establish longer open enrollment periods; Expressed concern about the proliferation of narrow provider networks, that tight provider networks coupled with inaccurate provider directories create a frustrating, confusing and expensive experience for patients seeking care from their preferred physicians. Advocated to the Senate Health, Education, Labor and Pensions (HELP) Committee on the need to stabilize the health insurance market, including the need to fund cost-sharing reduction (CSRs) payments for the long-term. Immigration: Voiced support to Congress on the need to pass the Development, Relief, and Education for Alien Minors (DREAM) Act of 2017, H.R. 3440. This legislation would establish a three-step pathway to U.S. citizenship through college, work, or the armed services for individuals who were born in another country and brought illegally to the U.S. at a young age (DREAMers). Clinical Labs: Commented to the Centers for Medicare and Medicaid Services (CMS) on issues pertaining to the Protecting Access to Medicare Act of 2014 (PAMA), specifically citing concerns about the potential impacts of PAMA on patient access to critical rapid clinical testing services offered to patients while they are receiving medical care in their physicians office; expressed further concerns about impending cuts on Jan. 1, 2018 for physician office-based testing services. Medicare Physician Fee Schedule: Commented to CMS on the CY2018 proposed rule on the Physician Fee Schedule, including: any revisions made to the E/M documentation guidelines should not result in a revaluation of the entire E/M code set; all relevant stakeholders, including medical specialty organizations, should work with both the Current Procedural Terminology (CPT) Editorial Panel and CMS to create frameworks outlining general principles of care that are beneficial and appropriate for medical specialties in describing the varying approaches to patient care for the current levels of E/M codes.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program; voiced strong opposition to the American Health Care Act/Better Care Reconciliation Act/Graham-Cassidy proposal because these bills would cap the federal contribution to Medicaid or block grant the program, end support for Medicaid expansion, allow state waivers to eliminate essential evidence-based benefits, cut funding for opioid use treatment, restrict access to womens health services, and replace the Affordable Care Acts income-based premium and cost-saving subsidies with regressive age-based ones that will raise premiums and deductibles for most Americans, especially, for older, poorer and sicker patients. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments in 2019; proposing specific alternatives to CMS Advancing Care Information program that is to replace the current Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Clinical Practice Improvement categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians; that CMS use its authority to adjust resource use down from 10 percent in the first performance period by setting resource use at zero and increasing the quality performance category by 10 percent to make up for the difference; that CMS ensures the utmost transparency in how the Agency attributes cost, based on the use of the patient relationship categories and codes, along with the codes for care episodes and patient conditions; that CMS allow all Accountable Care Organizations (ACOs) to be eligible to participate in Track 1+ and to not restrict participation based on ACO size or composition (ex. only physician-led ACOs or small ACOs); that CMS allow current ACOs to move into Track 1+ at the start of any performance year and not be required to wait until the beginning of their next three-year agreement period; that Track 1+ utilize the same benchmarking methodology used for the other MSSP tracks; that CMS implement a minimum threshold of 5,000 beneficiaries for Track 1+, which is consistent with the other MSSP tracks but is lower than the 10,000 (or 7,500 for rural ACOs) beneficiary threshold used in the Next Generation ACO model. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. Urged lawmakers to combine DGME and IME into a single, more functional payment program, and broaden the GME financing structure to include all payers; Allocate GME funds transparently and specifically to activities that further the educational mission of teaching and training residents and fellows with input from practicing clinicians and in collaboration with their professional organizations. FY2018 Appropriations: Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps. Also, advocated for the reauthorization of critical workforce programs that expired on Sept. 30, 2017 including, Community Health Centers, the Teaching Health Center Graduate Medical Education program, the National Health Services Corps, and expiring on Dec. 8th, the Title VII Health Professions programs. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their cost-sharing reduction subsidies (CSRs) and that those CSRs should be continued indefinitely as part of a larger bipartisan effort to stabilize the individual insurance market. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reducing Administrative Burdens on Physicians: Urged Congress to reduce administrative tasks that negatively impact physicians and patients, including: 1)Encourage the administration to convene a multi-agency task force to identify tasks that could be streamlined or eliminated, based on a new comprehensive framework to assess the intent and impact of administrative tasks on care as proposed in ACPs policy paper, Putting Patients First by Reducing Administrative Tasks in Health Care, 2) Establish a process to require that CMS and other relevant federal agencies reexamine and replace the existing E/M documentation guidelines with input from practicing clinicians and their professional organizations, 3) Call on federal advisory bodies, such as the Medicare Payment Advisory Commission (MedPAC), to research the effect of administrative tasks on patient and family care experience and outcomes, 4) Facilitate congressional hearings among government, clinician stakeholders, EHR vendors and suppliers to foster collaboration between parties to recognize their role and responsibility in reducing health IT administrative burdens. Opioid Abuse: ACP supports efforts in trying to improve access to care and treatment for those suffering from mental health and substance abuse disorders. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP is supportive of expanding access to naloxone within the community. ACP also supports the policy proposal known as partial-fill. This would allow a patient to elect to receive a portion of a prescription, and return for either a portion of, or the remainder of the prescription, if the pain persists, up to a 30-day maximum. Urged lawmakers to include language in the final House opioids legislative package to ensure healthcare providers who are engaged in population health initiatives have access to the medical records they need, including information on substance use disorders, to effectively and safely treat their patients; Urged lawmakers to reach agreement on a final conference report to the Comprehensive Addiction and Recovery Act (CARA) that would include: Development of a federal interagency task force to review, modify, and update, as appropriate, best practices for pain management and prescribing pain medication; Grants to states to expand awareness and education of physicians, patients, health care providers regarding the risks associated with the misuse of opioids; A comprehensive Prescription Drug Monitoring Program (PDMP) to track the dispensing of controlled substances; Increased availability of opioid overdose reversal drugs; Alternatives to incarceration to individuals who misuse opioid drugs and other substances to manage their pain. Zika: ACP urged lawmakers to pass legislation that would provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the Zika virus that is commensurate with the public health emergency that the virus represents. Prescription Drugs: ACP advocated support for lawmakers efforts in preventing some brand-name drug-companies from using statutorily required Food and Drug Administration (FDA) risk and safety programs to stifle other companies development of generic and biosimilar versions of brand-name drugs, specifically through introduction of the CREATES Act. Urged lawmakers to increase transparency in drug pricing by requiring pharmaceutical manufacturers to publically disclose production costs including research and development investments for specific high�cost drugs that the Secretary identifies through regulation; Authorize and appropriate $2.74 billion in discretionary spending for the FDA to expedite, through fast-track approval, new drugs that address unmet medical need in the treatment of a serious or life threatening condition, as well as to address the back-log of pending generic drug applications; Grant authority to the Secretary of HHS to negotiate prescription drug prices with manufacturers for prescription drugs covered under Part D of the Medicare program. Expressed support for S. 41, the Medicare Prescription Drug Price Negotiation Act that will empower the Secretary of Health and Human Services to negotiate with pharmaceutical manufacturers the prices (including discounts, rebates, and other price concessions) that may be charged for prescription drugs covered under Medicare Part D in prescription drug plans that participate in this program; Supported provisions in the FDA Reauthorization Act that provide goal dates for all outstanding generic applications; establishment of priority review timelines for generic drugs; and efforts to continue building the biosimilars review program. Medical Liability Reform: Expressed support for H.R. 1215, the Protecting Access to Care Act of 2017, which would set a federal limit on the amount of non-economic damages to $250,000 and would enact a fair share rule that specifies that in any health care lawsuit, each party shall be liable for that partys share of damages only and not for the share of any other person. It would specify that any state law that imposes different standards on non-economic damages or separate limits on a partys share of damages would supersede any new caps imposed by this legislation regardless of whether the amount imposed by the states is greater or less than those imposed by H.R. 1215; Supported legislation that allows physicians who document adherence to certain evidence-based clinical-practice guidelines and, when applicable, appropriate use criteria, a safe harbor from medical malpractice litigation, as proposed by the Saving Lives, Saving Cost Act, H.R. 1565. Chronic Care Management: Urged lawmakers to eliminate the beneficiary co-pay for chronic care management (CCM) services, require reimbursement and coverage of additional codes for more complex CCM services, direct HHS to authorize payment for CCM codes to allow physicians to spend up to 40 minutes with a patient and an additional code that would allow for 60 minutes of treatment for a patient with multiple chronic illnesses; Advocated for passage of The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, S. 870, which would expand the use of tele-health for individuals with stroke, provide flexibility for Medicare beneficiaries to be part of an Accountable Care Organization, extend the Independence at Home model of care. Telemedicine: Urged lawmakers to broadly lift geographic restrictions on telemedicine, facilitate the use of such telehealth services in stroke treatment, and incorporate the use of these services into ACOs, cosponsor bipartisan legislation, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) For Health Act (the CONNECT For Health Act), H.R. 4442/S. 2484, which would expand the use of telemedicine and remote patient monitoring (RPM) services by physicians to improve care of patients enrolled in Medicare. Mental Health: Urged lawmakers to establish grants, including Innovation and Demonstration grants, to State and local governments, educational institutions, and nonprofit organizations for integrating or coordinating physical health, mental health and substance abuse services; Provide a defined portion of grant funding to the effective integration of services to address mental illness and substance abuse within the primary care setting and to expand a workforce trained to integrate behavioral health within the primary care setting. Childrens Health: Advocated for a 5-year extension of the Childrens Health Insurance Program (CHIP), which expired on Sept. 30, 2017, on the basis of it serving as the key health insurance safety net program for children of low-income families. Insurance Market Stabilization: Commented on the Centers for Medicare and Medicaid Services (CMS) Proposed Rule: Patient Protection and Affordable Care Act; Market Stabilization. Specifically, the Agency should not allow issuers to deny coverage enrollees with bad debt; instead, the issuer should be required to enroll the individual and allow the enrollee to pay the outstanding debt over a period of time; recommended that the open enrollment period for plan year 2018 begin on November 1, 2017 and end on January 31, 2018; States operating a state-based, state-based/federal platform, and partnership marketplaces should be permitted to establish longer open enrollment periods; Expressed concern about the proliferation of narrow provider networks, that tight provider networks coupled with inaccurate provider directories create a frustrating, confusing and expensive experience for patients seeking care from their preferred physicians. Advocated to the Senate Health, Education, Labor and Pensions (HELP) Committee on the need to stabilize the health insurance market, including the need to fund cost-sharing reduction (CSRs) payments for the long-term. Immigration: Voiced support to Congress on the need to pass the Development, Relief, and Education for Alien Minors (DREAM) Act of 2017, H.R. 3440. This legislation would establish a three-step pathway to U.S. citizenship through college, work, or the armed services for individuals who were born in another country and brought illegally to the U.S. at a young age (DREAMers). Clinical Labs: Commented to the Centers for Medicare and Medicaid Services (CMS) on issues pertaining to the Protecting Access to Medicare Act of 2014 (PAMA), specifically citing concerns about the potential impacts of PAMA on patient access to critical rapid clinical testing services offered to patients while they are receiving medical care in their physicians office; expressed further concerns about impending cuts on Jan. 1, 2018 for physician office-based testing services. Medicare Physician Fee Schedule: Commented to CMS on the CY2018 proposed rule on the Physician Fee Schedule, including: any revisions made to the E/M documentation guidelines should not result in a revaluation of the entire E/M code set; all relevant stakeholders, including medical specialty organizations, should work with both the Current Procedural Terminology (CPT) Editorial Panel and CMS to create frameworks outlining general principles of care that are beneficial and appropriate for medical specialties in describing the varying approaches to patient care for the current levels of E/M codes.

HR 1106 Small Tracts Conveyance Act HR 1281, S 1627 Highlands Conservation Act Extension HR 1434, S 571 Chattahoochee-Oconee National Forest Land Adjustment Act S 569 Land and Water Conservation Authorization and Funding Act S 896 Land and Water Conservation Fund Authorization HR 1965 LAND Act HR 1157 Monomoy National Wildlife Refuge HR 1350, S 502 Voyageurs National Park H Res 5 House Rules Package HR 232 State National Forest Management Act S Con Res 3 FY 17 Budget Resolution HR 267 Martin Luther King Jr. National Historic Park Act HR 344 Forest Legacy Management Flexibility Act S 32 California Desert Protection and Recreation Act HR 502 Land and Water Conservation Fund Authorization S 117 Alex Diekmann Peak Designation Act HR 763, S 257 Acadia National Park Boundary Clarification Act HR 621 Disposal of Excess Federal Lands Act S 363, HR 1026 North Country National Scenic Trail Route Adjustment Act H Con Res 27 America's Federal Public Lands HR 1099 North American Wetlands Conservation Extension Act HR 2167 Acre In Acre Out Act HR 1424 National Scenic Trails Parity Act S 751, HR 2584 National Park Service Legacy Act HR 2863 Land and National Park Deferred Maintenance Act HR 2862 Wildfire Disaster Funding Act HR 2936 Resilient Federal Forests Act HR 2950 Making Public Lands Public Act S 1460 Energy and National Resources Act S 1514 Hunting Heritage and Environmental Legacy Preservation for Wildlife Act S 1522, HR 3186 Every Kid Outdoors Act HR 3668 SHARE Act

Client expense: $46,847 · Firm income: Not reported

HR 1106 Small Tracts Conveyance Act HR 1281, S 1627 Highlands Conservation Act Extension HR 1434, S 571 Chattahoochee-Oconee National Forest Land Adjustment Act S 569 Land and Water Conservation Authorization and Funding Act S 896 Land and Water Conservation Fund Authorization HR 1965 LAND Act HR 1157 Monomoy National Wildlife Refuge HR 1350, S 502 Voyageurs National Park H Res 5 House Rules Package HR 232 State National Forest Management Act S Con Res 3 FY 17 Budget Resolution HR 267 Martin Luther King Jr. National Historic Park Act HR 344 Forest Legacy Management Flexibility Act S 32 California Desert Protection and Recreation Act HR 502 Land and Water Conservation Fund Authorization S 117 Alex Diekmann Peak Designation Act HR 763, S 257 Acadia National Park Boundary Clarification Act HR 621 Disposal of Excess Federal Lands Act S 363, HR 1026 North Country National Scenic Trail Route Adjustment Act H Con Res 27 America's Federal Public Lands HR 1099 North American Wetlands Conservation Extension Act HR 2167 Acre In Acre Out Act HR 1424 National Scenic Trails Parity Act S 751, HR 2584 National Park Service Legacy Act HR 2863 Land and National Park Deferred Maintenance Act HR 2862 Wildfire Disaster Funding Act HR 2936 Resilient Federal Forests Act HR 2950 Making Public Lands Public Act S 1460 Energy and National Resources Act S 1514 Hunting Heritage and Environmental Legacy Preservation for Wildlife Act S 1522, HR 3186 Every Kid Outdoors Act HR 3668 SHARE Act

Client expense: $46,848 · Firm income: Not reported

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program; voiced strong opposition to the American Health Care Act/Better Care Reconciliation Act because this legislation would cap the federal contribution to Medicaid or block grant the program, end support for Medicaid expansion, allow state waivers to eliminate essential evidence-based benefits, cut funding for opioid use treatment, restrict access to womens health services, and replace the Affordable Care Acts income-based premium and cost-saving subsidies with regressive age-based ones that will raise premiums and deductibles for most Americans, especially, for older, poorer and sicker patients. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments in 2019; proposing specific alternatives to CMS Advancing Care Information program that is to replace the current Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Clinical Practice Improvement categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians; that CMS use its authority to adjust resource use down from 10 percent in the first performance period by setting resource use at zero and increasing the quality performance category by 10 percent to make up for the difference; that CMS ensures the utmost transparency in how the Agency attributes cost, based on the use of the patient relationship categories and codes, along with the codes for care episodes and patient conditions; that CMS allow all Accountable Care Organizations (ACOs) to be eligible to participate in Track 1+ and to not restrict participation based on ACO size or composition (ex. only physician-led ACOs or small ACOs); that CMS allow current ACOs to move into Track 1+ at the start of any performance year and not be required to wait until the beginning of their next three-year agreement period; that Track 1+ utilize the same benchmarking methodology used for the other MSSP tracks; that CMS implement a minimum threshold of 5,000 beneficiaries for Track 1+, which is consistent with the other MSSP tracks but is lower than the 10,000 (or 7,500 for rural ACOs) beneficiary threshold used in the Next Generation ACO model. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. Urged lawmakers to combine DGME and IME into a single, more functional payment program, and broaden the GME financing structure to include all payers; Allocate GME funds transparently and specifically to activities that further the educational mission of teaching and training residents and fellows with input from practicing clinicians and in collaboration with their professional organizations. FY2018 Appropriations: Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their premium subsidies in the event that the Supreme Court rules in favor of the petitioners in the King versus Burwell case. Congress should not make changes in the ACA that would result in more uninsured persons or weaken consumer protections. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reducing Administrative Burdens on Physicians: Urged Congress to reduce administrative tasks that negatively impact physicians and patients, including: 1)Encourage the administration to convene a multi-agency task force to identify tasks that could be streamlined or eliminated, based on a new comprehensive framework to assess the intent and impact of administrative tasks on care as proposed in ACPs policy paper, Putting Patients First by Reducing Administrative Tasks in Health Care, 2) Establish a process to require that CMS and other relevant federal agencies reexamine and replace the existing E/M documentation guidelines with input from practicing clinicians and their professional organizations, 3) Call on federal advisory bodies, such as the Medicare Payment Advisory Commission (MedPAC), to research the effect of administrative tasks on patient and family care experience and outcomes, 4) Facilitate congressional hearings among government, clinician stakeholders, EHR vendors and suppliers to foster collaboration between parties to recognize their role and responsibility in reducing health IT administrative burdens. Opioid Abuse: ACP supports efforts in trying to improve access to care and treatment for those suffering from mental health and substance abuse disorders. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP is supportive of expanding access to naloxone within the community. ACP also supports the policy proposal known as partial-fill. This would allow a patient to elect to receive a portion of a prescription, and return for either a portion of, or the remainder of the prescription, if the pain persists, up to a 30-day maximum. Urged lawmakers to include language in the final House opioids legislative package to ensure healthcare providers who are engaged in population health initiatives have access to the medical records they need, including information on substance use disorders, to effectively and safely treat their patients; Urged lawmakers to reach agreement on a final conference report to the Comprehensive Addiction and Recovery Act (CARA) that would include: Development of a federal interagency task force to review, modify, and update, as appropriate, best practices for pain management and prescribing pain medication; Grants to states to expand awareness and education of physicians, patients, health care providers regarding the risks associated with the misuse of opioids; A comprehensive Prescription Drug Monitoring Program (PDMP) to track the dispensing of controlled substances; Increased availability of opioid overdose reversal drugs; Alternatives to incarceration to individuals who misuse opioid drugs and other substances to manage their pain. Zika: ACP urged lawmakers to pass legislation that would provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the Zika virus that is commensurate with the public health emergency that the virus represents. Prescription Drugs: ACP advocated support for lawmakers efforts in preventing some brand-name drug-companies from using statutorily required Food and Drug Administration (FDA) risk and safety programs to stifle other companies development of generic and biosimilar versions of brand-name drugs, specifically through introduction of the CREATES Act. Urged lawmakers to increase transparency in drug pricing by requiring pharmaceutical manufacturers to publically disclose production costs including research and development investments for specific high�cost drugs that the Secretary identifies through regulation; Authorize and appropriate $2.74 billion in discretionary spending for the FDA to expedite, through fast-track approval, new drugs that address unmet medical need in the treatment of a serious or life threatening condition, as well as to address the back-log of pending generic drug applications; Grant authority to the Secretary of HHS to negotiate prescription drug prices with manufacturers for prescription drugs covered under Part D of the Medicare program. Expressed support for S. 41, the Medicare Prescription Drug Price Negotiation Act that will empower the Secretary of Health and Human Services to negotiate with pharmaceutical manufacturers the prices (including discounts, rebates, and other price concessions) that may be charged for prescription drugs covered under Medicare Part D in prescription drug plans that participate in this program; Supported provisions in the FDA Reauthorization Act that provide goal dates for all outstanding generic applications; establishment of priority review timelines for generic drugs; and efforts to continue building the biosimilars review program. Medical Liability Reform: Expressed support for H.R. 1215, the Protecting Access to Care Act of 2017, which would set a federal limit on the amount of non-economic damages to $250,000 and would enact a fair share rule that specifies that in any health care lawsuit, each party shall be liable for that partys share of damages only and not for the share of any other person. It would specify that any state law that imposes different standards on non-economic damages or separate limits on a partys share of damages would supersede any new caps imposed by this legislation regardless of whether the amount imposed by the states is greater or less than those imposed by H.R. 1215; Supported legislation that allows physicians who document adherence to certain evidence-based clinical-practice guidelines and, when applicable, appropriate use criteria, a safe harbor from medical malpractice litigation, as proposed by the Saving Lives, Saving Cost Act, H.R. 1565. Chronic Care Management: Urged lawmakers to eliminate the beneficiary co-pay for chronic care management (CCM) services, require reimbursement and coverage of additional codes for more complex CCM services, direct HHS to authorize payment for CCM codes to allow physicians to spend up to 40 minutes with a patient and an additional code that would allow for 60 minutes of treatment for a patient with multiple chronic illnesses. Telemedicine: Urged lawmakers to broadly lift geographic restrictions on telemedicine, facilitate the use of such telehealth services in stroke treatment, and incorporate the use of these services into ACOs, cosponsor bipartisan legislation, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) For Health Act (the CONNECT For Health Act), H.R. 4442/S. 2484, which would expand the use of telemedicine and remote patient monitoring (RPM) services by physicians to improve care of patients enrolled in Medicare. Mental Health: Urged lawmakers to establish grants, including Innovation and Demonstration grants, to State and local governments, educational institutions, and nonprofit organizations for integrating or coordinating physical health, mental health and substance abuse services; Provide a defined portion of grant funding to the effective integration of services to address mental illness and substance abuse within the primary care setting and to expand a workforce trained to integrate behavioral health within the primary care setting. 21st Century Cures Act: Advocated with Congress on several elements of the 21st Century Cures Act, comprehensive legislation designed to accelerate the discovery, development, and delivery of new cures and treatments. These elements included: support for moving the health information technology (health IT) ecosystem toward an interoperable health information network, combatting business practices that inhibit the flow of information by establishing authority for the HHS Office of Inspector General to investigate claims of information blocking and assign penalties for activities found to be interfering with the lawful sharing of electronic information, ensuring that health care clinicians are not penalized for the failure of developers of health IT in the case of information blocking, the establishment of hardship exemptions from Meaningful Use and the Merit-Based Incentive Payment System (MIPS) payment adjustments due to the decertification of an electronic health record (EHR) and, a commitment to develop a strategy around reducing regulatory and administrative burdens, improving and increasing access to treatment for patients suffering from mental health and substance use disorders and ensure better understanding and enforcement of mental health parity laws, accelerating the integration of behavioral health into the primary care setting. Insurance Market Stabilization: Commented on the Centers for Medicare and Medicaid Services (CMS) Proposed Rule: Patient Protection and Affordable Care Act; Market Stabilization. Specifically, the Agency should not allow issuers to deny coverage enrollees with bad debt; instead, the issuer should be required to enroll the individual and allow the enrollee to pay the outstanding debt over a period of time; recommended that the open enrollment period for plan year 2018 begin on November 1, 2017 and end on January 31, 2018; States operating a state-based, state-based/federal platform, and partnership marketplaces should be permitted to establish longer open enrollment periods; Expressed concern about the proliferation of narrow provider networks, that tight provider networks coupled with inaccurate provider directories create a frustrating, confusing and expensive experience for patients seeking care from their preferred physicians.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program; voiced strong opposition to the American Health Care Act/Better Care Reconciliation Act because this legislation would cap the federal contribution to Medicaid or block grant the program, end support for Medicaid expansion, allow state waivers to eliminate essential evidence-based benefits, cut funding for opioid use treatment, restrict access to womens health services, and replace the Affordable Care Acts income-based premium and cost-saving subsidies with regressive age-based ones that will raise premiums and deductibles for most Americans, especially, for older, poorer and sicker patients. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments in 2019; proposing specific alternatives to CMS Advancing Care Information program that is to replace the current Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Clinical Practice Improvement categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians; that CMS use its authority to adjust resource use down from 10 percent in the first performance period by setting resource use at zero and increasing the quality performance category by 10 percent to make up for the difference; that CMS ensures the utmost transparency in how the Agency attributes cost, based on the use of the patient relationship categories and codes, along with the codes for care episodes and patient conditions; that CMS allow all Accountable Care Organizations (ACOs) to be eligible to participate in Track 1+ and to not restrict participation based on ACO size or composition (ex. only physician-led ACOs or small ACOs); that CMS allow current ACOs to move into Track 1+ at the start of any performance year and not be required to wait until the beginning of their next three-year agreement period; that Track 1+ utilize the same benchmarking methodology used for the other MSSP tracks; that CMS implement a minimum threshold of 5,000 beneficiaries for Track 1+, which is consistent with the other MSSP tracks but is lower than the 10,000 (or 7,500 for rural ACOs) beneficiary threshold used in the Next Generation ACO model. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. Urged lawmakers to combine DGME and IME into a single, more functional payment program, and broaden the GME financing structure to include all payers; Allocate GME funds transparently and specifically to activities that further the educational mission of teaching and training residents and fellows with input from practicing clinicians and in collaboration with their professional organizations FY2018 Appropriations: Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their premium subsidies in the event that the Supreme Court rules in favor of the petitioners in the King versus Burwell case. Congress should not make changes in the ACA that would result in more uninsured persons or weaken consumer protections. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Reducing Administrative Burdens on Physicians: Urged Congress to reduce administrative tasks that negatively impact physicians and patients, including: 1)Encourage the administration to convene a multi-agency task force to identify tasks that could be streamlined or eliminated, based on a new comprehensive framework to assess the intent and impact of administrative tasks on care as proposed in ACPs policy paper, Putting Patients First by Reducing Administrative Tasks in Health Care, 2) Establish a process to require that CMS and other relevant federal agencies reexamine and replace the existing E/M documentation guidelines with input from practicing clinicians and their professional organizations, 3) Call on federal advisory bodies, such as the Medicare Payment Advisory Commission (MedPAC), to research the effect of administrative tasks on patient and family care experience and outcomes, 4) Facilitate congressional hearings among government, clinician stakeholders, EHR vendors and suppliers to foster collaboration between parties to recognize their role and responsibility in reducing health IT administrative burdens. Opioid Abuse: ACP supports efforts in trying to improve access to care and treatment for those suffering from mental health and substance abuse disorders. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP is supportive of expanding access to naloxone within the community. ACP also supports the policy proposal known as partial-fill. This would allow a patient to elect to receive a portion of a prescription, and return for either a portion of, or the remainder of the prescription, if the pain persists, up to a 30-day maximum. Urged lawmakers to include language in the final House opioids legislative package to ensure healthcare providers who are engaged in population health initiatives have access to the medical records they need, including information on substance use disorders, to effectively and safely treat their patients; Urged lawmakers to reach agreement on a final conference report to the Comprehensive Addiction and Recovery Act (CARA) that would include: Development of a federal interagency task force to review, modify, and update, as appropriate, best practices for pain management and prescribing pain medication; Grants to states to expand awareness and education of physicians, patients, health care providers regarding the risks associated with the misuse of opioids; A comprehensive Prescription Drug Monitoring Program (PDMP) to track the dispensing of controlled substances; Increased availability of opioid overdose reversal drugs; Alternatives to incarceration to individuals who misuse opioid drugs and other substances to manage their pain. Zika: ACP urged lawmakers to pass legislation that would provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the Zika virus that is commensurate with the public health emergency that the virus represents. Prescription Drugs: ACP advocated support for lawmakers efforts in preventing some brand-name drug-companies from using statutorily required Food and Drug Administration (FDA) risk and safety programs to stifle other companies development of generic and biosimilar versions of brand-name drugs, specifically through introduction of the CREATES Act. Urged lawmakers to increase transparency in drug pricing by requiring pharmaceutical manufacturers to publically disclose production costs including research and development investments for specific high�cost drugs that the Secretary identifies through regulation; Authorize and appropriate $2.74 billion in discretionary spending for the FDA to expedite, through fast-track approval, new drugs that address unmet medical need in the treatment of a serious or life threatening condition, as well as to address the back-log of pending generic drug applications; Grant authority to the Secretary of HHS to negotiate prescription drug prices with manufacturers for prescription drugs covered under Part D of the Medicare program. Expressed support for S. 41, the Medicare Prescription Drug Price Negotiation Act that will empower the Secretary of Health and Human Services to negotiate with pharmaceutical manufacturers the prices (including discounts, rebates, and other price concessions) that may be charged for prescription drugs covered under Medicare Part D in prescription drug plans that participate in this program; Supported provisions in the FDA Reauthorization Act that provide goal dates for all outstanding generic applications; establishment of priority review timelines for generic drugs; and efforts to continue building the biosimilars review program. Medical Liability Reform: Expressed support for H.R. 1215, the Protecting Access to Care Act of 2017, which would set a federal limit on the amount of non-economic damages to $250,000 and would enact a fair share rule that specifies that in any health care lawsuit, each party shall be liable for that partys share of damages only and not for the share of any other person. It would specify that any state law that imposes different standards on non-economic damages or separate limits on a partys share of damages would supersede any new caps imposed by this legislation regardless of whether the amount imposed by the states is greater or less than those imposed by H.R. 1215; Supported legislation that allows physicians who document adherence to certain evidence-based clinical-practice guidelines and, when applicable, appropriate use criteria, a safe harbor from medical malpractice litigation, as proposed by the Saving Lives, Saving Cost Act, H.R. 1565. Chronic Care Management: Urged lawmakers to eliminate the beneficiary co-pay for chronic care management (CCM) services, require reimbursement and coverage of additional codes for more complex CCM services, direct HHS to authorize payment for CCM codes to allow physicians to spend up to 40 minutes with a patient and an additional code that would allow for 60 minutes of treatment for a patient with multiple chronic illnesses. Telemedicine: Urged lawmakers to broadly lift geographic restrictions on telemedicine, facilitate the use of such telehealth services in stroke treatment, and incorporate the use of these services into ACOs, cosponsor bipartisan legislation, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) For Health Act (the CONNECT For Health Act), H.R. 4442/S. 2484, which would expand the use of telemedicine and remote patient monitoring (RPM) services by physicians to improve care of patients enrolled in Medicare. Mental Health: Urged lawmakers to establish grants, including Innovation and Demonstration grants, to State and local governments, educational institutions, and nonprofit organizations for integrating or coordinating physical health, mental health and substance abuse services; Provide a defined portion of grant funding to the effective integration of services to address mental illness and substance abuse within the primary care setting and to expand a workforce trained to integrate behavioral health within the primary care setting. 21st Century Cures Act: Advocated with Congress on several elements of the 21st Century Cures Act, comprehensive legislation designed to accelerate the discovery, development, and delivery of new cures and treatments. These elements included: support for moving the health information technology (health IT) ecosystem toward an interoperable health information network, combatting business practices that inhibit the flow of information by establishing authority for the HHS Office of Inspector General to investigate claims of information blocking and assign penalties for activities found to be interfering with the lawful sharing of electronic information, ensuring that health care clinicians are not penalized for the failure of developers of health IT in the case of information blocking, the establishment of hardship exemptions from Meaningful Use and the Merit-Based Incentive Payment System (MIPS) payment adjustments due to the decertification of an electronic health record (EHR) and, a commitment to develop a strategy around reducing regulatory and administrative burdens, improving and increasing access to treatment for patients suffering from mental health and substance use disorders and ensure better understanding and enforcement of mental health parity laws, accelerating the integration of behavioral health into the primary care setting. Insurance Market Stabilization: Commented on the Centers for Medicare and Medicaid Services (CMS) Proposed Rule: Patient Protection and Affordable Care Act; Market Stabilization. Specifically, the Agency should not allow issuers to deny coverage enrollees with bad debt; instead, the issuer should be required to enroll the individual and allow the enrollee to pay the outstanding debt over a period of time; recommended that the open enrollment period for plan year 2018 begin on November 1, 2017 and end on January 31, 2018; States operating a state-based, state-based/federal platform, and partnership marketplaces should be permitted to establish longer open enrollment periods; Expressed concern about the proliferation of narrow provider networks, that tight provider networks coupled with inaccurate provider directories create a frustrating, confusing and expensive experience for patients seeking care from their preferred physicians.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program; voiced strong opposition to the American Health Care Act in March 2017 because it would cap the federal contribution to Medicaid or block grant the program, end support for Medicaid expansion, repeal essential evidence-based benefits, or replace the Affordable Care Acts income-based premium and cost-saving subsidies with regressive age-based ones that will raise premiums and deductibles for most Americans, especially, for older, poorer and sicker patients. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments in 2019; proposing specific alternatives to CMS Advancing Care Information program that is to replace the current Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Clinical Practice Improvement categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians; that CMS use its authority to adjust resource use down from 10 percent in the first performance period by setting resource use at zero and increasing the quality performance category by 10 percent to make up for the difference; that CMS ensures the utmost transparency in how the Agency attributes cost, based on the use of the patient relationship categories and codes, along with the codes for care episodes and patient conditions; that CMS allow all Accountable Care Organizations (ACOs) to be eligible to participate in Track 1+ and to not restrict participation based on ACO size or composition (ex. only physician-led ACOs or small ACOs); that CMS allow current ACOs to move into Track 1+ at the start of any performance year and not be required to wait until the beginning of their next three-year agreement period; that Track 1+ utilize the same benchmarking methodology used for the other MSSP tracks; that CMS implement a minimum threshold of 5,000 beneficiaries for Track 1+, which is consistent with the other MSSP tracks but is lower than the 10,000 (or 7,500 for rural ACOs) beneficiary threshold used in the Next Generation ACO model. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. Urged lawmakers to combine DGME and IME into a single, more functional payment program, and broaden the GME financing structure to include all payers; Allocate GME funds transparently and specifically to activities that further the educational mission of teaching and training residents and fellows with input from practicing clinicians and in collaboration with their professional organizations. FY2017 Appropriations: Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their premium subsidies in the event that the Supreme Court rules in favor of the petitioners in the King versus Burwell case. Congress should not make changes in the ACA that would result in more uninsured persons or weaken consumer protections. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Health Information Technology: Commented to HHS Office of the National Coordinator for Health Information Technologys (ONCs) Draft 2017 Interoperability Standards Advisory (ISA), recommending that ONC focus its efforts to identify, repair, and mitigate the negative effects of rapidly spreading bad data; rather than requiring EHRs and other clinical health IT to support multiple separate standards for extracting data for quality, public health, research, payment, and other reporting purposes, ONC should commission development of a single application programming interface (API) for all of the query and data extraction requirements. Urged lawmakers to require the Office of the National Coordinator (ONC) to develop and implement national EHR interoperability standards with direct input from practicing clinicians on the necessary data elements for care delivery, quality improvement and reporting, including the need for a narrative that provides the context of the care needed; Exempt clinicians in small/medium-sized practices from unfunded mandates that require them to purchase health IT software, services or infrastructure to support data exchanges with little or no clinical value, as determined by the Secretary with input from practicing physicians. Opioid Abuse: ACP supports efforts in trying to improve access to care and treatment for those suffering from mental health and substance abuse disorders. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP is supportive of expanding access to naloxone within the community. ACP also supports the policy proposal known as partial-fill. This would allow a patient to elect to receive a portion of a prescription, and return for either a portion of, or the remainder of the prescription, if the pain persists, up to a 30-day maximum. Urged lawmakers to include language in the final House opioids legislative package to ensure healthcare providers who are engaged in population health initiatives have access to the medical records they need, including information on substance use disorders, to effectively and safely treat their patients; Urged lawmakers to reach agreement on a final conference report to the Comprehensive Addiction and Recovery Act (CARA) that would include: Development of a federal interagency task force to review, modify, and update, as appropriate, best practices for pain management and prescribing pain medication; Grants to states to expand awareness and education of physicians, patients, health care providers regarding the risks associated with the misuse of opioids; A comprehensive Prescription Drug Monitoring Program (PDMP) to track the dispensing of controlled substances; Increased availability of opioid overdose reversal drugs; Alternatives to incarceration to individuals who misuse opioid drugs and other substances to manage their pain. Zika: ACP urged lawmakers to pass legislation that would provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the Zika virus that is commensurate with the public health emergency that the virus represents. Prescription Drugs: ACP advocated support for lawmakers efforts in preventing some brand-name drug-companies from using statutorily required Food and Drug Administration (FDA) risk and safety programs to stifle other companies development of generic and biosimilar versions of brand-name drugs, specifically through introduction of the CREATES Act. Urged lawmakers to increase transparency in drug pricing by requiring pharmaceutical manufacturers to publically disclose production costs including research and development investments for specific high�cost drugs that the Secretary identifies through regulation; Authorize and appropriate $2.74 billion in discretionary spending for the FDA to expedite, through fast-track approval, new drugs that address unmet medical need in the treatment of a serious or life threatening condition, as well as to address the back-log of pending generic drug applications; Grant authority to the Secretary of HHS to negotiate prescription drug prices with manufacturers for prescription drugs covered under Part D of the Medicare program. Expressed support for S. 41, the Medicare Prescription Drug Price Negotiation Act that will empower the Secretary of Health and Human Services to negotiate with pharmaceutical manufacturers the prices (including discounts, rebates, and other price concessions) that may be charged for prescription drugs covered under Medicare Part D in prescription drug plans that participate in this program. Medical Liability Reform: Expressed support for H.R. 1215, the Protecting Access to Care Act of 2017, which would set a federal limit on the amount of non-economic damages to $250,000 and would enact a fair share rule that specifies that in any health care lawsuit, each party shall be liable for that partys share of damages only and not for the share of any other person. It would specify that any state law that imposes different standards on non-economic damages or separate limits on a partys share of damages would supersede any new caps imposed by this legislation regardless of whether the amount imposed by the states is greater or less than those imposed by H.R. 1215. Chronic Care Management: Urged lawmakers to eliminate the beneficiary co-pay for chronic care management (CCM) services, require reimbursement and coverage of additional codes for more complex CCM services, direct HHS to authorize payment for CCM codes to allow physicians to spend up to 40 minutes with a patient and an additional code that would allow for 60 minutes of treatment for a patient with multiple chronic illnesses. Telemedicine: Urged lawmakers to broadly lift geographic restrictions on telemedicine, facilitate the use of such telehealth services in stroke treatment, and incorporate the use of these services into ACOs, cosponsor bipartisan legislation, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) For Health Act (the CONNECT For Health Act), H.R. 4442/S. 2484, which would expand the use of telemedicine and remote patient monitoring (RPM) services by physicians to improve care of patients enrolled in Medicare. Mental Health: Urged lawmakers to establish grants, including Innovation and Demonstration grants, to State and local governments, educational institutions, and nonprofit organizations for integrating or coordinating physical health, mental health and substance abuse services; Provide a defined portion of grant funding to the effective integration of services to address mental illness and substance abuse within the primary care setting and to expand a workforce trained to integrate behavioral health within the primary care setting. 21st Century Cures Act: Advocated with Congress on several elements of the 21st Century Cures Act, comprehensive legislation designed to accelerate the discovery, development, and delivery of new cures and treatments. These elements included: support for moving the health information technology (health IT) ecosystem toward an interoperable health information network, combatting business practices that inhibit the flow of information by establishing authority for the HHS Office of Inspector General to investigate claims of information blocking and assign penalties for activities found to be interfering with the lawful sharing of electronic information, ensuring that health care clinicians are not penalized for the failure of developers of health IT in the case of information blocking, the establishment of hardship exemptions from Meaningful Use and the Merit-Based Incentive Payment System (MIPS) payment adjustments due to the decertification of an electronic health record (EHR) and, a commitment to develop a strategy around reducing regulatory and administrative burdens, improving and increasing access to treatment for patients suffering from mental health and substance use disorders and ensure better understanding and enforcement of mental health parity laws, accelerating the integration of behavioral health into the primary care setting. Vaccines: Expressed strong support to the President for the safety of vaccines; Claims that vaccines are unsafe when administered according to expert recommendations have been disproven by a robust body of medical literature, including a thorough review by the National Academy of Medicine (formerly known as the Institute of Medicine). Immigration (Health): Expressed concern that the executive order signed by President Trump on January 27, 2017 will result in discrimination against foreign-born persons from certain predominantly Muslim countries; that by restricting entry of physicians and medical students from seven designated Muslim majority countries, the order will undermine medical education and result in patients losing access to their doctors; that the 120 day ban on accepting refugees, and the indefinite ban on Syrian refugees, will contribute to an ongoing public health crisis for those affected, needlessly subjecting them to violence, injury, illness, deprivation and even death. Expressed support for S. 128, the Bar Removal of Individuals who Dream and Grow our Economy Act (BRIDGE Act), which would allow people who are eligible for or who have received work authorization and temporary relief from deportation through the Deferred Action for Childhood Arrivals (DACA) program to continue living in the U.S. with permission from the federal government for three years after the date of enactment of this legislation. Insurance Market Stabilization: Commented on the Centers for Medicare and Medicaid Services (CMS) Proposed Rule: Patient Protection and Affordable Care Act; Market Stabilization. Specifically, the Agency should not allow issuers to deny coverage enrollees with bad debt; instead, the issuer should be required to enroll the individual and allow the enrollee to pay the outstanding debt over a period of time; recommended that the open enrollment period for plan year 2018 begin on November 1, 2017 and end on January 31, 2018; States operating a state-based, state-based/federal platform, and partnership marketplaces should be permitted to establish longer open enrollment periods; Expressed concern about the proliferation of narrow provider networks, that tight provider networks coupled with inaccurate provider directories create a frustrating, confusing and expensive experience for patients seeking care from their preferred physicians.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program; voiced strong opposition to the American Health Care Act in March 2017 because it would cap the federal contribution to Medicaid or block grant the program, end support for Medicaid expansion, repeal essential evidence-based benefits, or replace the Affordable Care Acts income-based premium and cost-saving subsidies with regressive age-based ones that will raise premiums and deductibles for most Americans, especially, for older, poorer and sicker patients. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments in 2019; proposing specific alternatives to CMS Advancing Care Information program that is to replace the current Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Clinical Practice Improvement categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians; that CMS use its authority to adjust resource use down from 10 percent in the first performance period by setting resource use at zero and increasing the quality performance category by 10 percent to make up for the difference; that CMS ensures the utmost transparency in how the Agency attributes cost, based on the use of the patient relationship categories and codes, along with the codes for care episodes and patient conditions; that CMS allow all Accountable Care Organizations (ACOs) to be eligible to participate in Track 1+ and to not restrict participation based on ACO size or composition (ex. only physician-led ACOs or small ACOs); that CMS allow current ACOs to move into Track 1+ at the start of any performance year and not be required to wait until the beginning of their next three-year agreement period; that Track 1+ utilize the same benchmarking methodology used for the other MSSP tracks; that CMS implement a minimum threshold of 5,000 beneficiaries for Track 1+, which is consistent with the other MSSP tracks but is lower than the 10,000 (or 7,500 for rural ACOs) beneficiary threshold used in the Next Generation ACO model. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Advocated to protect Medicare beneficiary access to health care services by preserving existing Medicare financing for Graduate Medical Education (GME). In the 114th Congress, advocated for S.1148/H.R.2124 and H.R. 1117-to strategically increase the number of GME training positions in primary care specialties (including internal medicine) and other specialties facing shortages. Urged lawmakers to combine DGME and IME into a single, more functional payment program, and broaden the GME financing structure to include all payers; Allocate GME funds transparently and specifically to activities that further the educational mission of teaching and training residents and fellows with input from practicing clinicians and in collaboration with their professional organizations. FY2017 Appropriations: Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, health care for American Indians and Alaska natives, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Advocated to repeal the mandate that requires a prescription for over-the-counter medications purchased through a Health Savings Account. Advocated for legislation that would provide coverage under Medicare for voluntary consultations between doctors and patients to discuss advance care plans, as included in H.R. 1173, the Personalize Your Care Act of 2013; advocated in Aug. 2014 for the Medicare Advantage Participants Bill of Rights, H.R. 4998 and S. 2552, that would prevent Medicare Advantage plans from terminating physicians from Medicare Advantage plan networks without sufficient notice or cause. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their premium subsidies in the event that the Supreme Court rules in favor of the petitioners in the King versus Burwell case. Congress should not make changes in the ACA that would result in more uninsured persons or weaken consumer protections. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. National workforce policy to ensure sufficient numbers of primary care and other physicians: Increase funding for scholarships and loan repayment programs under Title VII as well as increase funding for the National Health Service Corps (NHSC); Provide new practice-entry bonus for scholarship or loan repayment award recipients who remain in underserved communities after completion of service obligation. Health Information Technology: Commented to HHS Office of the National Coordinator for Health Information Technologys (ONCs) Draft 2017 Interoperability Standards Advisory (ISA), recommending that ONC focus its efforts to identify, repair, and mitigate the negative effects of rapidly spreading bad data; rather than requiring EHRs and other clinical health IT to support multiple separate standards for extracting data for quality, public health, research, payment, and other reporting purposes, ONC should commission development of a single application programming interface (API) for all of the query and data extraction requirements. Urged lawmakers to require the Office of the National Coordinator (ONC) to develop and implement national EHR interoperability standards with direct input from practicing clinicians on the necessary data elements for care delivery, quality improvement and reporting, including the need for a narrative that provides the context of the care needed; Exempt clinicians in small/medium-sized practices from unfunded mandates that require them to purchase health IT software, services or infrastructure to support data exchanges with little or no clinical value, as determined by the Secretary with input from practicing physicians. Opioid Abuse: ACP supports efforts in trying to improve access to care and treatment for those suffering from mental health and substance abuse disorders. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP is supportive of expanding access to naloxone within the community. ACP also supports the policy proposal known as partial-fill. This would allow a patient to elect to receive a portion of a prescription, and return for either a portion of, or the remainder of the prescription, if the pain persists, up to a 30-day maximum. Urged lawmakers to include language in the final House opioids legislative package to ensure healthcare providers who are engaged in population health initiatives have access to the medical records they need, including information on substance use disorders, to effectively and safely treat their patients; Urged lawmakers to reach agreement on a final conference report to the Comprehensive Addiction and Recovery Act (CARA) that would include: Development of a federal interagency task force to review, modify, and update, as appropriate, best practices for pain management and prescribing pain medication; Grants to states to expand awareness and education of physicians, patients, health care providers regarding the risks associated with the misuse of opioids; A comprehensive Prescription Drug Monitoring Program (PDMP) to track the dispensing of controlled substances; Increased availability of opioid overdose reversal drugs; Alternatives to incarceration to individuals who misuse opioid drugs and other substances to manage their pain. Zika: ACP urged lawmakers to pass legislation that would provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the Zika virus that is commensurate with the public health emergency that the virus represents. Prescription Drugs: ACP advocated support for lawmakers efforts in preventing some brand-name drug-companies from using statutorily required Food and Drug Administration (FDA) risk and safety programs to stifle other companies development of generic and biosimilar versions of brand-name drugs, specifically through introduction of the CREATES Act. Urged lawmakers to increase transparency in drug pricing by requiring pharmaceutical manufacturers to publically disclose production costs including research and development investments for specific high�cost drugs that the Secretary identifies through regulation; Authorize and appropriate $2.74 billion in discretionary spending for the FDA to expedite, through fast-track approval, new drugs that address unmet medical need in the treatment of a serious or life threatening condition, as well as to address the back-log of pending generic drug applications; Grant authority to the Secretary of HHS to negotiate prescription drug prices with manufacturers for prescription drugs covered under Part D of the Medicare program. Expressed support for S. 41, the Medicare Prescription Drug Price Negotiation Act that will empower the Secretary of Health and Human Services to negotiate with pharmaceutical manufacturers the prices (including discounts, rebates, and other price concessions) that may be charged for prescription drugs covered under Medicare Part D in prescription drug plans that participate in this program. Medical Liability Reform: Expressed support for H.R. 1215, the Protecting Access to Care Act of 2017, which would set a federal limit on the amount of non-economic damages to $250,000 and would enact a fair share rule that specifies that in any health care lawsuit, each party shall be liable for that partys share of damages only and not for the share of any other person. It would specify that any state law that imposes different standards on non-economic damages or separate limits on a partys share of damages would supersede any new caps imposed by this legislation regardless of whether the amount imposed by the states is greater or less than those imposed by H.R. 1215. Chronic Care Management: Urged lawmakers to eliminate the beneficiary co-pay for chronic care management (CCM) services, require reimbursement and coverage of additional codes for more complex CCM services, direct HHS to authorize payment for CCM codes to allow physicians to spend up to 40 minutes with a patient and an additional code that would allow for 60 minutes of treatment for a patient with multiple chronic illnesses. Telemedicine: Urged lawmakers to broadly lift geographic restrictions on telemedicine, facilitate the use of such telehealth services in stroke treatment, and incorporate the use of these services into ACOs, cosponsor bipartisan legislation, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) For Health Act (the CONNECT For Health Act), H.R. 4442/S. 2484, which would expand the use of telemedicine and remote patient monitoring (RPM) services by physicians to improve care of patients enrolled in Medicare. Mental Health: Urged lawmakers to establish grants, including Innovation and Demonstration grants, to State and local governments, educational institutions, and nonprofit organizations for integrating or coordinating physical health, mental health and substance abuse services; Provide a defined portion of grant funding to the effective integration of services to address mental illness and substance abuse within the primary care setting and to expand a workforce trained to integrate behavioral health within the primary care setting. 21st Century Cures Act: Advocated with Congress on several elements of the 21st Century Cures Act, comprehensive legislation designed to accelerate the discovery, development, and delivery of new cures and treatments. These elements included: support for moving the health information technology (health IT) ecosystem toward an interoperable health information network, combatting business practices that inhibit the flow of information by establishing authority for the HHS Office of Inspector General to investigate claims of information blocking and assign penalties for activities found to be interfering with the lawful sharing of electronic information, ensuring that health care clinicians are not penalized for the failure of developers of health IT in the case of information blocking, the establishment of hardship exemptions from Meaningful Use and the Merit-Based Incentive Payment System (MIPS) payment adjustments due to the decertification of an electronic health record (EHR) and, a commitment to develop a strategy around reducing regulatory and administrative burdens, improving and increasing access to treatment for patients suffering from mental health and substance use disorders and ensure better understanding and enforcement of mental health parity laws, accelerating the integration of behavioral health into the primary care setting. Vaccines: Expressed strong support to the President for the safety of vaccines; Claims that vaccines are unsafe when administered according to expert recommendations have been disproven by a robust body of medical literature, including a thorough review by the National Academy of Medicine (formerly known as the Institute of Medicine). Immigration (Health): Expressed concern that the executive order signed by President Trump on January 27, 2017 will result in discrimination against foreign-born persons from certain predominantly Muslim countries; that by restricting entry of physicians and medical students from seven designated Muslim majority countries, the order will undermine medical education and result in patients losing access to their doctors; that the 120 day ban on accepting refugees, and the indefinite ban on Syrian refugees, will contribute to an ongoing public health crisis for those affected, needlessly subjecting them to violence, injury, illness, deprivation and even death. Expressed support for S. 128, the Bar Removal of Individuals who Dream and Grow our Economy Act (BRIDGE Act), which would allow people who are eligible for or who have received work authorization and temporary relief from deportation through the Deferred Action for Childhood Arrivals (DACA) program to continue living in the U.S. with permission from the federal government for three years after the date of enactment of this legislation. Insurance Market Stabilization: Commented on the Centers for Medicare and Medicaid Services (CMS) Proposed Rule: Patient Protection and Affordable Care Act; Market Stabilization. Specifically, the Agency should not allow issuers to deny coverage enrollees with bad debt; instead, the issuer should be required to enroll the individual and allow the enrollee to pay the outstanding debt over a period of time; recommended that the open enrollment period for plan year 2018 begin on November 1, 2017 and end on January 31, 2018; States operating a state-based, state-based/federal platform, and partnership marketplaces should be permitted to establish longer open enrollment periods; Expressed concern about the proliferation of narrow provider networks, that tight provider networks coupled with inaccurate provider directories create a frustrating, confusing and expensive experience for patients seeking care from their preferred physicians.